Subclinical hypothyroidism (SCH), characterized by elevated serum thyroid-stimulating hormone (TSH) levels and normal free thyroxine levels, usually presents without symptoms, and is often discovered incidentally during routine blood test. The Task Force of the Korean Thyroid Association Committee of Clinical Practice Guidelines has established a guideline to evaluate and manage SCH; the guideline emphasizes the implementation of diagnostic criteria based on the TSH reference range for Koreans and focuses on the proven health benefits of levothyroxine (LT4) treatment. Based on the Korea National Health and Nutrition Examination Survey (2013-2015), serum TSH level of 6.8 mIU/L is considered the reference value for SCH. SCH can be categorized as mild (TSH 6.8-10.0 mIU/L) or severe (TSH ＞10.0 mIU/L), and patients are classified as adults (age ＜70 years) or elderly patients (age ≥70years) depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, along with the thyroid peroxidase antibody test, preferably 2-3 months after the initial evaluation. Usually, LT4 treatment is not recommended for mild SCH in adults; however, treatment is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and can be considered for coexisting dyslipidemia. LT4 treatment is not recommended for mild or even severe SCH in elderly patients, in general. Patients with SCH who receive LT4 treatment, the LT4 dosage should be personalized, and serum TSH levels should be monitored to ensure optimal LT4 dosage (dosage that is neither excessive nor insufficient). Patients with SCH who do not receive LT4 treatment require periodic follow-up at appropriate testing intervals determined by disease severity. The guideline also provides several educational points applicable in clinical settings.

BACKGROUND: Iodine is an intrinsic element of thyroid hormone, which is essential for childhood growth and development. The Ideal Breast Milk (IBM) cohort study aims to evaluate the effects of maternal iodine status during pregnancy and lactation on maternal thyroid function, offspring growth and development, and offspring thyroid function. METHODS: The IBM cohort study recruited pregnant women from Seoul National University Hospital between June 2016 and August 2017, followed by enrollment of their offspring after delivery. For the maternal participants, iodine status is evaluated by urinary iodine concentration (UIC) and dietary records in the third trimester and at 3 to 4 weeks and 12 to 15 months postpartum. For the child participants, cord blood sampling and UIC measurements are performed at birth. At 3 to 4 weeks of age, UIC and breastmilk iodine concentrations are measured. At 12 to 15 months of age, growth and development are assessed and measurements of UIC, a thyroid function test, and ultrasonography are performed. RESULTS: A total of 198 pregnant women in their third trimester were recruited. Their mean age was 35.1±3.5 years, and 78 (39.4%) of them were pregnant with twins. Thirty-three (16.7%) of them had a previous history of thyroid disease. CONCLUSION: Korea is an iodine-replete area. In particular, lactating women in Korea are commonly exposed to excess iodine due to the traditional practice of consuming brown seaweed soup postpartum. The study of the IBM cohort is expected to contribute to developing guidelines for optimal iodine nutrition in pregnant or lactating women.
Breast* ; Child ; Cohort Studies* ; Cordocentesis ; Diet Records ; Female ; Growth and Development* ; Humans ; Infant ; Iodine* ; Korea ; Lactation* ; Milk, Human* ; Parturition ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women ; Prospective Studies* ; Seaweed ; Seoul ; Thyroid Diseases ; Thyroid Function Tests ; Thyroid Gland* ; Twins ; Ultrasonography

A 36 year-old man and his 6 month-old daughter presented with multiple, slightly depressed, skin-colored, hard nodules and plaques on the abdomen, back, and both extremities. They also showed abnormal physical appearance, including short stature and neck, round face, and short digits, which suggested Albright's hereditary osteodystrophy (AHO). Histopathologically, various sized bony spicules were present in the dermis. The laboratory results showed normal serum calcium, phosphorus and parathyroid hormone levels. On the basis of clinical, laboratory and histologic findings, we diagnosed these cases as Albright's hereditary osteodystrophy with cutaneous ossification occurring in pseudopseudohypoparathyroidism.
Abdomen ; Calcium ; Dermis ; Extremities ; Fibrous Dysplasia, Polyostotic ; Neck ; Nuclear Family ; Parathyroid Hormone ; Phosphorus ; Pseudopseudohypoparathyroidism

A 36 year-old man and his 6 month-old daughter presented with multiple, slightly depressed, skin-colored, hard nodules and plaques on the abdomen, back, and both extremities. They also showed abnormal physical appearance, including short stature and neck, round face, and short digits, which suggested Albright's hereditary osteodystrophy (AHO). Histopathologically, various sized bony spicules were present in the dermis. The laboratory results showed normal serum calcium, phosphorus and parathyroid hormone levels. On the basis of clinical, laboratory and histologic findings, we diagnosed these cases as Albright's hereditary osteodystrophy with cutaneous ossification occurring in pseudopseudohypoparathyroidism.
Abdomen ; Calcium ; Dermis ; Extremities ; Fibrous Dysplasia, Polyostotic ; Neck ; Nuclear Family ; Parathyroid Hormone ; Phosphorus ; Pseudopseudohypoparathyroidism

An Armored tube is known to be the most effective in maintaining of airway patency during anesthesia in any position. Unfortunately, the tube itself may become the cause of airway obstruction. One of the known complications of the armored tube is a separation of the individual latex layers. This can be caused by herniation into the lumen. Diffusion of nitrous oxide into the inner hernia considerably intensifies the obstruction. The bubbles in the tube wall arise during manufacturing as well as during resterilization. A 62-year-old man with herniation of lumbar disc herniation was intubated with a 8.0 mm armored tube for general anesthesia. 30 minutes later, we experienced signs of partial endotracheal tube obstruction including high arterial PCO2 and inspiratory pressure in prone position. Then, tube suction with catheter was done and signs was slightly improved. But, 90 minutes later, passage of suction catheter was impossible. When operation was finished, patient was turned to supine position. We exchanged the tube with another tube and found inner wall herniation into the armored tube lumen caused by layer separation.
Airway Obstruction* ; Anesthesia ; Anesthesia, General ; Catheters ; Diffusion ; Hernia ; Humans ; Latex ; Middle Aged ; Nitrous Oxide ; Prone Position ; Suction ; Supine Position

In the literature, descriptions of the MR findings of renal leiomyoma are rare. We present the MR findings ofa capsular leiomyoma of the kidney in which hy pointensity relative to normal renal parenchyma was seen on bothT1- and T2-weighted MR images.
Kidney ; Leiomyoma* ; Magnetic Resonance Imaging*

PURPOSE: To evaluate the additive value of multiphasic contrast-enhanced dynamic MR imaging as a supple-mentto dual-echo T2-weighted TSE MR imaging for the differentiation of solid, malignant hepatic lesions from nonsolid,benign hepatic lesions. MATERIALS AND METHODS: Two radiologists retrospectively reviewed dual-echo T2-weightedTSE MR images and gadolinium-enhanced MR images in 51 patients with hepatic lesions (28 malignant, 69 benign). Forthe dif-ferentiation of malignant from benign lesions, as seen on dual-echo T2-weighted TSE MR images, weevaluated sensitivity, specificity, and accuracy, and compared with the results with those for dual echoT2-weighted MR images plus multiphasic contrast-enhanced dynamic MR images. In addition, Az values for dual echoT2-weighted MR images were compared with those for dual echo T2-weighted MR images plus multiphasiccon-trast-enhanced dynamic MR images. RESULTS: For the differentiation of malignant from benign hepatic lesions,as seen on dual-echo T2-weighted TSE images, sensitivity, specificity, and accuracy were 80.0 %, 97.5 %, and 93.9%, respectively, for lesions less than 3 cm in diameter, and 92.3 %, 95.0 %, and 93.5 %, respectively, for thosethat were 3 cm or larger. The results for dual-echo T2-weighted MR imaging plus multiphasic contrast-enhanceddynamic MR imaging were 86.7%, 100.0%, and 97.3%, respectively, for lesions less than 3 cm, and 92.3%, 100.0 %,and 95.7 %, re-spectively for those that were 3 cm or larger. There were no significant differences insensitivity, specificity, or accuracy between the results obtained using dual-echo T2-weighted MR imaging andthose obtained with d-ual- echo T2-weighted MR imaging plus multiphasic contrast-enhanced dynamic MR imaging. Norwere there statistically significant differences in Az values between the two groups. CONCLUSIONS: For thedifferentiation of solid, malignant hepatic lesions from nonsolid, benign hepatic lesions, there is no differencein accuracy between dual-echo T2-weighted TSE MR imaging and the additional use of multiphasic contrast-enhancedMR imaging. Dual-echo T2-weighted TSE MR imaging may, therefore, be use-ful for the differentiation of solid,malignant hepatic lesions from nonsolid, benign hepatic lesions without the use of multiphasic contrast-enhancedMR imaging.
Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; Sensitivity and Specificity

Patients with inflammatory bowel disease who fail to respond to first-line agents such as 5-ASA compounds and corticosteroids can benefit from immunomodulating medications. In past years, the short-term effectiveness of CsA in Inflammatory bowel disease(IBD) has been reported, but the long-term efficacy, benefit, and safety of this therapy have not been fully established yet. This study was conducted using a total of 60 IBD patients with long-term follow-up from among the 82 patients who visited the IBD Clinic, Song Do Hospital, Seoul, ROK, from Jan. 1994 to Dec. 1996. The effectiveness of CsA was analyzed with respect to induction and maintenance of the remission in the 43 patients with ulcerative colitis(UC) and 17 the patients with Crohn's disease(CD). Treatment on admission was with intravenous CsA (4mg/kg/day) for 7-10 days in 15 patients with UC and in 13 patients with CD. These 28 patients were unresponsive to conventional treatment and had a recurrence of symptoms on refractory to first-line agents. Following the intravenous induction of cyclosporine, the patients continued to receive oral CsA (2.0-5.0mg/Bd.wt/day). In another group, 28 patients with UC and 4 patients with CD who were nonresponsive to or had recurrence of symptoms with first-line agents were treated with oral CsA. The mean period of treatment with CsA was an average of 10 months for CD and 7.5 months for UC. The CsA blood levels were measured by whole blood monoclonal radioimmunoassay, and levels of 200-400 ng per milliliter were obtained. Among the 43 patients with UC, 33 patients had remission (77%) within a mean induction time of 3.2 months and maintained remission for a mean of 7.1 months. Of the 15 patients with UC who had been admitted for CsA IV therapy, all the patients had remission within a mean of 2.8 months and maintained remission for 6.5 months. Among the 17 patients with CD, 9 patients had remission (52.1%) within a mean of 2.7 months and remained in remission for a mean of 8.6 months. Of the 13 patients with CD who had been admitted for CsA IV therapy, 7 patients (53.8%) had remission within a mean of 2.6 months and maintained remission for a mean of 8.0 months. During the management with an average medium dosage of CsA, no serious side effects or toxicity was observed. In this study, initial cyclosporine IV (4mg/kg/day) therapy, followed by PO (2-5mg/kg/day) therapy was effective in achieving remission in ulcerative colitis but not in Crohn's disease, and the initial continuous intravenous infusion of CsA induced a more rapid and prolonged remission than oral CsA. During the induction and maintenance of remission, serious side effects were not found during the period of this study. In cases of acute or severe and refractory inflammatory bowel disease or of recurrence after conventional therapy, the continuous intravenous infusion of CsA for 7-10 days will induce a more rapid and prolonged remission than the oral administration of CsA.
Administration, Oral ; Adrenal Cortex Hormones ; Colitis, Ulcerative* ; Crohn Disease* ; Cyclosporine* ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases* ; Infusions, Intravenous ; Music ; Radioimmunoassay ; Recurrence ; Seoul ; Ulcer*