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Papillary Thyroid Carcinoma Hidden behind the Hot Nodule.

Min Ji JEON ; Ji Min HAN ; Ji Hye YIM ; Tae Yong KIM ; Won Bae KIM ; Young Kee SHONG

Journal of Korean Thyroid Association.2012;5(1):78-79. doi:10.11106/jkta.2012.5.1.78

52-year-old woman was presented with palpitation and weight loss. Thyroid function test revealed low thyroid-stimulating hormone level with upper normal range of Free T4 and thyroid scan showed 2 cm hot nodule in left upper pole. Thyroid ultrasonography was also done and it showed two nodules in left upper pole. The one was considered as functioning benign nodule, but the other nodule was compatible with malignancy. She underwent total thyroidectomy and final pathology revealed papillary thyroid carcinoma.
Carcinoma ; Female ; Humans ; Middle Aged ; Reference Values ; Thyroid Function Tests ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin ; Weight Loss

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A Follicular Thyroid Carcinoma Presenting as Single Bone Metastasis to Distal Femur with Pathologic Fracture: a Case Report.

Sang Mi KIM ; Yun Kyung JEON ; Sang Soo KIM ; Bo Hyun KIM ; In Ju KIM

Journal of Korean Thyroid Association.2012;5(1):73-77. doi:10.11106/jkta.2012.5.1.73

Follicular carcinomas are the second most common form of thyroid cancer. There are a few cases regarding initial presentation of a patient with distant metastasis leading to the diagnosis of follicular thyroid carcinoma. Most follicular thyroid carcinomas present as asymptomatic thyroid nodules, but the first sign of the disease is occasionally lymph-node metastases or in rare cases lung or bone metastases. Thirteen percentage of patients had distant metastasis at presentation, and bone metastasis constituted the majority. Vertebrae, pelvis, ribs, and femur were common sites of bone metastasis. Thus, case of metastasis to the femur only from follicular thyroid carcinoma is very rare. We recently experienced a case of follicular thyroid carcinoma with metastasis to the femur who presented with bone pain and pathologic fracture. We present this case with a review of the literature.
Adenocarcinoma, Follicular ; Femur ; Fractures, Spontaneous ; Humans ; Lung ; Neoplasm Metastasis ; Pelvis ; Ribs ; Spine ; Thyroid Neoplasms ; Thyroid Nodule

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Inadvertent Parathyroidectomy during Thyroid Surgery for Papillary Thyroid Carcinoma and Postoperative Hypocalcemia.

Dongbin AHN ; Jin Ho SOHN ; Jae Hyug KIM ; Ji Young PARK ; Junesik PARK

Journal of Korean Thyroid Association.2012;5(1):65-72. doi:10.11106/jkta.2012.5.1.65

BACKGROUND AND OBJECTIVES: The aim of this article is to report our experience of inadvertent parathyroidectomy during thyroid surgery and to analyze its associated factors and clinical implications. In addition, we attempted to determined causative factors that result in permanent hypocalcemia after thyroid surgery. MATERIALS AND METHODS: We performed a retrospective review of 500 patients who underwent thyroid surgery for the treatment of papillary thyroid carcinoma from 2004 to 2008. RESULTS: Inadvertent parathyroidectomy was identified in 7.4% of patients and only 1 parathyroid gland was inadvertently removed in most cases. The incidence of inadvertent parathyroidectomy was not associated with gender, age, type of surgical procedure, tumor size, coexisting Hashimoto's thyroiditis (HT), extra-thyroidal extension (ETE), lymph node (LN) metastasis, and surgeon's experience. Nor was inadvertent parathyroidectomy associated with permanent postoperative hypocalcemia. Although operating time >120 min, ETE, and total thyroidectomy (TT) with central neck dissection (CND) were found to be related to permanent hypocalcemia on univariate analysis, tumor size > or =1 cm and surgeon's experience < or =5 years was statistically associated with permanent hypocalcemia on both univariate and multivariate analyses. CONCLUSION: Although inadvertent parathyroidectomy is not an uncommon complication of thyroid surgery, it appears to have only modest clinical implications. Permanent hypocalcemia was significantly associated with tumor size > or =1 cm and short surgical experience of surgeons, especially in the case of TT with CND. Therefore, we suggest that more accurate risk stratification should be made for routine CND, when it is performed by young surgeons.
Carcinoma ; Humans ; Hypocalcemia ; Incidence ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Parathyroid Glands ; Parathyroidectomy ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Thyroiditis

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Usefulness of Sialendoscopy for Sialadenitis after Radioactive Iodine Therapy.

Jeong Seok CHOI ; Jae Yol LIM ; Young Mo KIM

Journal of Korean Thyroid Association.2012;5(1):60-64. doi:10.11106/jkta.2012.5.1.60

BACKGROUND AND OBJECTIVES: Ablation of the thyroid remnants using radioiodine (RI) after surgical removal of differentiated thyroid cancer could induce radiation-related salivary gland dysfunction. The purpose of this study is to review our experience with therapeutic sialendoscopy for RI-induced sialadenitis. MATERIALS AND METHODS: We reviewed medical charts of all patients with RI-induced sialadenitis treated with sialendoscopy retrospectively. The study included 14 patients who underwent sialendoscopy for the treatment of RI-induced sialadenitis after failing conservative management. RESULTS: 14 patients (11 women, 3 men) with a mean age of 43.8 years (range, 26-60) underwent interventional sialendoscopy for the treatment of RI-induced sialadenitis that is unresponsive to conservative management. Symptoms arising from the parotid gland were seen in 12 (86%) of patients, whereas symptoms arising from the submandibular gland were seen in 2 (14%). 7 patients (50%) presented symptoms in bilateral parotid or submandibular glands. The mean dose of RI was 203.2 mCi (range, 150-500) received as a single dose. The mean duration from RI ablation therapy to sialendoscopy was 11.1 months (range, 0.5-29). Sialendoscopy was possible in all patients. Ductal stenosis and mucus plugs and debris were the most common types of ductal pathology. Sialendoscopy improved the symptoms in 79% (11/14) of patients, with no serious complications reported in mean follow up of 4 months (range, 1-12). CONCLUSION: Therapeutic interventional sialendoscopy appears to provide symptom improvement in most patients. Sialendoscopy is effective tool for improving symptoms due to RI-induced sialadenitis in patients who are unresponsive to conservative managements.
Constriction, Pathologic ; Female ; Follow-Up Studies ; Humans ; Iodine ; Mucus ; Parotid Gland ; Retrospective Studies ; Salivary Glands ; Sialadenitis ; Submandibular Gland ; Thyroid Gland ; Thyroid Neoplasms

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Clinical Review of Thyroid Dysfunction in the Subjects for Health Check-up.

Ji Eun PARK ; Ho Chan CHO

Journal of Korean Thyroid Association.2012;5(1):52-59. doi:10.11106/jkta.2012.5.1.52

BACKGROUND AND OBJECTIVES: Thyroid disorders are common endocrine disease with various clinical symptoms. Biochemical function tests are important to detect thyroid function disorders, but guideline for screening of thyroid dysfunction is controversial. Therefore, in this study, we aimed to investigate the prevalence and clinical significance of thyroid dysfunctions with analyses of public screening and follow-up results on our hospital. MATERIALS AND METHODS: This study was performed on 3309 subjects (1753 men, 1556 women) that visited in our health promotion center for periodic health examination from January to June 2007, with review of medical records. Serum T3, Free T4, and thyroid-stimulating hormone concentrations were measured with radioimmunoassay using commercial kits, and ultrasonogram and scan of thyroid were conducted if needed. RESULTS: The study showed the prevalence of thyroid dysfunction was 11.8% (389 cases) and among the subjects, prevalence of undiagnosed hyperthyroidism and hypothyroidism were 1.8% (7 cases) and 3.1% (12 cases), subclinical hyperthyroidism and subclinical hypothyroidism was 0.5% (2 cases) and 4.9% (19 cases). However, prevalence of normal thyroid function with follow up clinically was 37.3% (145 cases). CONCLUSION: This study indicates significance of screening and confirmation through follow-up for thyroid disorders with high prevalence of thyroid dysfunctions with guidelines to minimize the false positive results.
Endocrine System Diseases ; Follow-Up Studies ; Health Promotion ; Humans ; Hyperthyroidism ; Hypothyroidism ; Male ; Mass Screening ; Medical Records ; Prevalence ; Radioimmunoassay ; Thyroid Gland ; Thyrotropin

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Immunohistochemical Expression of CXC Chemokine Receptor 4 and Galectin-3 in Follicular Tumors of Thyroid.

Ji Eun PARK ; Bu Kyung KIM ; Sangeon GWOO ; Yo Han PARK ; Young Sik CHOI ; Young Ok KIM

Journal of Korean Thyroid Association.2012;5(1):45-51. doi:10.11106/jkta.2012.5.1.45

BACKGROUND AND OBJECTIVES: Follicular tumors can present a difficult diagnostic challenge for cytological evaluation and ultrasound findings. Therefore, new methods which could help distinguish follicular adenoma from follicular carcinoma simply and accurately are greatly desired. This study investigated the usefulness of immnunohistochemical expression of CXC chemokine receptor 4 (CXCR4) and galectin-3 as marker of differentiated thyroid carcinomas. MATERIALS AND METHODS: Expression of CXCR4 and galectin-3 were examined immunohistochemically in the 60 paraffin embedded tissues which were already diagnosed as follicular adenoma (n=20), follicullar carcinoma (n=20), and papillary carcinoma (n=20) of thyroid. RESULTS: Galatin-3 was expressed significantly high in follicular carcinoma than follicular adenoma (p=0.022). CXCR4 was also expressed significantly high in follicular carcinoma than follicular adenoma (p=0.027). The sensitivity of CXCR4 and galectin-3 was 70% and 80% and specificity, 65% and 60% for differential diagnosis of follicular tumors. CONCLUSION: An immunohistochemical panel, including galatin-3 and CXCR4, could be useful in the differential diagnosis between follicular adenoma from follicular carcinoma.
Adenoma ; Carcinoma, Papillary ; Diagnosis, Differential ; Galectin 3 ; Paraffin ; Receptors, CXCR ; Receptors, CXCR4 ; Sensitivity and Specificity ; Thyroid Gland

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Alpha-Lipoic Acid Decreases Iodine Uptake in the Rat Thyroid Cell Line FRTL-5.

Ji Hye YIM ; Tae Yong KIM ; Sergio RUIZ-LLORENTE ; Won Gu KIM ; Ji Min HAN ; Min Ji JEON ; Won Bae KIM ; Young Kee SHONG

Journal of Korean Thyroid Association.2012;5(1):39-44. doi:10.11106/jkta.2012.5.1.39

BACKGROUND AND OBJECTIVES: Alpha-lipoic acid (ALA) is a naturally occurring fatty acid with strong antioxidant properties that exerts protective effects against harmful free radical damage. The aim of the present study was to assess the effect of ALA on iodine uptake and expression of sodium iodine symporter (NIS) using FRTL-5 cells. MATERIALS AND METHODS: Cells were treated with ALA for various time and doses, in the presence or absence of thyrotropin (TSH). Cell viability assay, iodine uptake assay and NIS promoter activity assay were performed. RESULTS: ALA increased NIS promoter activity. It showed an additive effect when concomitantly added with TSH. After 48 hours of incubation with ALA in the presence or absence of TSH, there was no difference in iodine uptake according to doses of ALA. After 72 hours of incubation with ALA and TSH, ALA decreased iodine uptake in dose-dependent way. CONCLUSION: ALA induced NIS gene transcription of FRTL-5, but suppressed iodine uptake in the presence of TSH. ALA may suppress iodine uptake through effect for post-translation stage of NIS protein.
Animals ; Cell Line ; Cell Survival ; Iodine ; Ion Transport ; Rats ; Sodium ; Symporters ; Thioctic Acid ; Thyroid Gland ; Thyrotropin

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Long-Term Effect of Prolonged TSH Suppression on the Skeletal System.

Min Hee KIM ; Moo Il KANG

Journal of Korean Thyroid Association.2012;5(1):31-38. doi:10.11106/jkta.2012.5.1.31

Thyroid hormone (TH) has a pivotal role in skeletal development, linear growth and maintenance of adult bone mass. Additionally, there are several studies which supported the direct effect of thyroid-stimulating hormone (TSH) on bone metabolism. As thyroid disease is one of the most common endocrine problems, the clinical impact of thyroid dysfunction on bone metabolism has been elucidated in various studies. Hyperthyroidism is associated with excessive loss of bone mass and an increased life-time risk for fractures. Adverse effects of hyperthyroidism in bone metabolism are distinct in postmenopausal women. Subclinical hyperthyroidism may also affect bone mineral density, however, its effect on fracture rate remains to be established. The effect of exogenous TH on bone tissue is somewhat controversial. Patients with hypothyroidism or differentiated thyroid carcinoma showing suppressed TSH caused by excessive TH replacement, especially postmenopausal women, appear to have lower bone mineral density and higher incidence of fractures than euthyroid subjects without exogenous TH. On the contrary, patients who are on exogenous TH with a normal range of TSH seem to have similar bone mineral density and fracture rates as euthyroid subjects. As most patients with differentiated thyroid carcinoma are taking exogenous thyroid hormone to suppress TSH, individual risks of both fracture and recurrence of carcinoma should be evaluated during the follow-up period of those patients. In general, in the management of thyroid disease, it should be taken into account that most thyroid dysfunction may result in reduced bone density and an increased fracture rate.
Adult ; Bone and Bones ; Bone Density ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Recurrence ; Reference Values ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyrotrophs ; Thyrotropin

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Effect of Prolonged TSH Suppression on Cardiovascular System.

Jong Min SONG

Journal of Korean Thyroid Association.2012;5(1):25-30. doi:10.11106/jkta.2012.5.1.25

Prolonged thyroid-stimulating hormone (TSH) suppression caused by exogenous subclinical thyrotoxicosis has been reported to impose harmful effects on cardiovascular system. Those effects involve increase in heart rate and myocardial mass, impaired ventricular diastolic and systolic function, decreased exercise capacity, decreased arterial elasticity, development of atrial tachyarrhythmia, and increase in cardiovascular adverse events. Tailored dose adjustment of thyroid hormone under the guidance of TSH level for obviating oversuppression of TSH, and use of beta blockers can reduce cardiovascular adverse effects in patients who undergo thyroid hormone therapy.
Cardiovascular System ; Elasticity ; Heart Rate ; Humans ; Tachycardia ; Thyroid Gland ; Thyrotoxicosis ; Thyrotrophs ; Thyrotropin

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Postoperative Follow-Up of Differentiated Thyroid Cancer: Use of Thyroglobulin Assay.

Tae Yong KIM

Journal of Korean Thyroid Association.2012;5(1):20-24. doi:10.11106/jkta.2012.5.1.20

Stimulated thyroglobulin measured 6-12 months after thyroidectomy and radioactive iodine remnant ablation is a very useful guidance for risk-stratification. Thus, this parameter should be a main variable of strategy for follow-up in such patients. Serum Tg and TgAb measurement at the time of ablation just after total thyroidectomy could give a helpful data supporting stimulated Tg measured 6-12 months after radioactive iodine remnant ablation and should be considered in your own follow-up strategies.
Biomarkers ; Follow-Up Studies ; Humans ; Iodine ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

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