갑상선 전절제술의 안정성

윤효영,장이찬,최재운 충북대학교 의과대학 충북대학교 의학연구소 1998 忠北醫大學術誌 Vol.8 No.1

연구목적 : 갑상선암의 외과적 치료는 갑상선의 부분절제술에서 갑상선 전절제술까지 다양한 수술이 적용되고 있다. 갑상선 전절제술은 술후 영구적 칼슘저하증 및 반회후두신경 손상의 위험성에도 불구하고, 최근에는 갑상선암에서 그 적용 빈도가 증가하고 있다. 충북대학교병원 외과에서 갑상선 전절제술을 시행한 26명의 환자를 대상으로 국소 합병증을 조사하여 갑상선 전절제술의 안정성을 알아보고자 하였다. 대상 및 방법 : 1993년 1월부터 1997년 12월까지 충북대학교병원 외과에서 갑상선암으로 갑상선 전절제술을 시행한 26명의 환자의 의무기록을 바탕으로 갑상선 전절제술후의 국소 합병증에 대하여 후향적으로 조사하였다. 결과 : 26명의 환자중 9명의 환자에서 총 11례의 국소 합병증이 발생하였다. 이중 술후 출혈 1례(3.8%), 일시적 애성 1례(3.8%), 영구성 애성 1례(3.8%), 일시적 칼슘저히증 5례(19.2%), 영구적 칼슘저히증 2례(7.7%), 흉관 손상 1례(3.8%)등이 있었으나 수술에 의한 사망 환자는 없었다. 결론 : 갑상선 전절제술후의 국소 합병증은 생각보다 높지 않아 갑상선암에서 우선적으로 고려 할 수 있겠다. Purpose : Surgical management of thyroid cancer varies from partial resection to total thyroidectomy with or without lymph node dissection. In spite of the risk of hypoparathyoidism and recurrent laryngeal nerve injury after total thyroidectomy, the frequency of this operation is increasing recently. We reviewed 26 total thyroidectomies performed at our hospital to evaluate local complication and risk after total thyroidectomy. Materials and Methods : We reviewed medical records of 26 patients who underwent total thyroidectomy due to thyroid cancer from January 1993 to December 1997. Results : The eleven postoperative local complication occurred in 9 patients among 26 patients : postoperative bleeding in (3.8%), temporary hoarseness in 1(3.8%), permanent hoarseness in 1(3.8%), temporary hypoparathyroidism in 5(19.2%), permanent hypoparathyroidism in 2(7.7%), thoracic duct injury in 1(3.8%) without postoperative mortality. Conclusion : The incidence of complications after total thyroidectomy is not so high that it should be consider as the primary treatment of thyroid cancer.

갑상선암의 내시경 갑상선 절제술에서 근전절제술 및 전절제술의 임상적 비교

유한모,김태원,배자성<SUP>1<,SUP>,조항주,김기환,안창혁,박우찬<SUP>2<,SUP>,이동호<SUP>3<,SUP>,김정수,Han Mo Yoo,M,D,Tae Won Kim,M,D,Ja Sung Bae,M,D,<SUP>1<,SUP>,Hang Joo Cho,M,D,Kee Hwan Kim,M,D,Chang Hyuk An,M,D,Woo Chan Park,M 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.4

Purpose: The aim of this study was to evaluate and compare the surgical outcomes of endoscopic total and near-total thyroidectomies in patients with thyroid cancer. Methods: Between February 2000 and January 2009, among 387 patients who underwent endoscopic thyroidectomy in our hospital, we evaluated 50 patients who underwent endoscopic total or near-total thyroidectomy. Thirty- five and 15 patients underwent endoscopic total thyroidectomy and near-total thyroidectomy, respectively. We analyzed the patients' clinicopathologic characteristics and post-operative complications between the two groups. Results: The mean size of tumors was 1.08 cm (range, 0.1∼3.5 cm) and the mean operative time was 192 minutes. Forty-nine tumors were papillary cancers and 1 tumor was a follicular cancer. Two patients in the endoscopic total thyroidectomy group underwent re-operation because of bleeding. In the near-total thyroidectomy group, one patient had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. In the total thyroidectomy group, nine patients had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. There was no statistical difference in the post-operative complicationrates between the two groups (P=0.254 for hypocalcemia and P=0.470 for injury to the recurrent laryngeal nerve). Conclusion: Based on our experience, endoscopic total thyroidectomy is a safe and feasible alternative to endoscopic near-total thyroidectomy. (Korean J Endocrine Surg 2009; 9:201-205)

갑상선암 환자에 대한 갑상선 전절제술과 방사성요오드치료가 수면무호흡과 코골이에 미치는 영향

오승현,김철승,최말례,최은혜,김형욱,한주희,김태형,김병조,박영삼,은헌정 대한신경정신의학회 2015 신경정신의학 Vol.54 No.4

Objectives Some paper claim thyroidectomy decreases snoring and sleep apnea symptoms and the opposite. The aim of this study is to evaluate and compare the effects of sleep apnea and snoring by total thyroidectomy and radioactive iodine (RI) therapy. Methods A total of 88 patients who underwent total thyroidectomy and RI therapy for thyroid cancer in the outpatient clinic of the department of surgery of a general hospital were recruited. Interviewers completed their demographic data, past medical history, and data on total thyroidec¬tomy and sleep apnea with snoring, and also preoperative and postoperative Pittsburgh Sleep Quality Index (PSQI), preoperative and postoperative Epworth Sleepiness Scale (ESS), preopera¬tive and postoperative Snoring Index (SI), preoperative and postoperative global life satisfaction (index of well-being) scale, and postoperative Beck Depression Inventory. Results The Wilcoxon Signed Ranks Test showed PSQI preoperative-postoperative p=0.750, ESS preoperative-postoperative p=0.000, SI preoperative-postoperative p=0.034, life satisfac¬tion preoperative-postoperative p=0.216 (based on negative ranks). Conclusion The above results indicate that snoring and daytime sleepiness increased after to¬tal thyroidectomy and RI therapy, suggesting that the patency of upper airway (UA) was reduced or the collapsibility of the UA increased after total thyroidectomy and RI therapy. That is, the above results indicate that sleep apnea and snoring were aggravated after total thyroidectomy and RI therapy.

갑상선암으로 갑상선 전절제술 및 경부 림프절 절제술 후 합병증

노수영,고병균,김연선,Soo Young Noh,Byung Kyun Ko and Yon Seon Kim 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.3

갑상선 유두암 환자의 전절제술 후 부갑상선 기능 저하증의 위험 인자

성지영(Ji Young Seong),이초록(Cho Rok Lee),김민지(Min Jhi Kim),김태형(Tae Hyung Kim),이슬기(Seul Gi Lee),최정범(Jung Bum Choi),반은정(Eun Jeong Ban),강상욱(Sang Wook Kang),이잔디(Jan Dee Lee),정종주(Jong Ju Jeong),남기현(Kee Hyun Nam 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.3

Purpose: Postoperative hypocalcemia is a common complication of thyroidectomy. This study evaluated the incidence and predisposing risk factors for postoperative permanent hypocalcemia after total thyroidectomy. Methods: There were 1,247 consecutive patients undergoing total thyroidectomy and complete treatment and observation for differentiated thyroid cancer between January 2012 to December 2012 who were enrolled in this study. Patients were divided into two groups, those remaining normalcalcemic (Group I-824 pts) and those who had hypocalcemia requiring treatment (Groups II-423 pts). Group II was subdivided into a transient hypocalcemic group (Group IIA-409 pts) and a permanent hypocalcemic group (Group IIB-14 pts). Results: Female gender, thyroiditis, preserved parathyroid number, lateral lymph node metastasis, RAI treatment, preoperative parathyroid hormone and preoperative vitamin D were significantly associated with the development of postoperative hypocalcemia by multivariate analysis. Comparing patients with transient versus permanent hypocalcemia, tumor size and multiplicity were significantly related to the development of permanent hypocalcemia by multivariate analysis. RAI treatment and parathyroid hormone level on the postoperative third day were significantly related to recovery from transient hypocalcemia to normo-calcemia. Conclusion: Risk factors of postoperative hypocalcemia were associated with preoperative patient factors and advanced thyroid cancer. Advanced thyroid cancer was a risk factor for permanent hypocalcemia. To prevent postoperative hypocalcemia, we should focus on patient condition and need to preserve parathyroid gland more carefully in thyroid surgery.

소아 분화 갑상선암의 15년 이상의 추적 관찰

김아람,성치원,박영삼,김철승,김갑태,A Ram Kim,M.D.,Chi Won Sung,M.D.,Young Sam Park,M.D.,Cheol Seung Kim,M.D.,Ph.D. and Kab Tae Kim,M.D.,Ph.D. 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.1

Purpose: Thyroid cancer is rare in childhood. Although thyroid cancer is biologically more aggressive in children because of the high incidence of lymph node metastasis and distant metastasis when compared with that of adults, the prognosis is better. This study investigated the prognosis of pediatric differentiated thyroid cancer with 15 years or greater follow-up and we consider the proper treatment of pediatric differentiated thyroid cancer. Methods: From January, 1979 to December, 1994 during 16 years, 17 patients younger than 17 years old and who underwent thyroid surgery for well differentiated thyroid cancer at the Department of Surgery at Presbyterian Medical Center were retrospectively reviewed by the medical records and they were interviewed by telephone. Results: Total thyroidectomy was performed in 4 patients (23.5%), subtotal thyroidectomy was performed in 10 patients (58.8%) and lobectomy was performed in 3 patients (17.7%). The mean follow-up period was 23.5 years (range: 15∼28.2 years) and recurrence was found in 7 cases (41.3%). Five cases (29.5%) showed locoregional recurrence and 2 cases (11.8%) showed distant metastasis. Postoperative radioiodine (<SUP>131</SUP>I) therapy was done in 6 cases (35%) and 6 cases (35%) underwent radioiodine therapy as a therapeutic modality for metastasis. Conclusion: The pediatric well differentiated thyroid cancer in this study showed high rates of lymph node metastasis at the time of diagnosis and a high recurrence rate, but the prognosis was good (100% overall survival rate during the follow-up period). Therefore, total thyroidectomy, radical lymph node dissection and postoperative radioiodine therapy are considered the initial patient management. This aggressive therapeutic management can decrease of the recurrence rate and increase the therapeutic effect. A radioiodine scan and thyroglobulin can used for follow-up. (Korean J Endocrine Surg 2010;10:34-38)

갑상선 전절제술 후 저칼슘혈증을 예측하기 위한 부갑상선호르몬 수치

나안수,김선광,김영욱,윤현조,정성후,Ahn Soo Na,Seon Kwang Kim,Young Wook Kim,Hyun Jo Youn and Sung Hoo Jung 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.1

Purpose: The aim of study was to determine the cut-off value of serum parathyroid hormone levels with a predictive value for the occurrence of clinical hypocalcemia following total thyroidectomy. Methods: We performed a retrospective review, of 150 patients who underwent total thyroidectomy for papillary thyroid carcinoma from January 2010 to July 2010. We measured the serum levels of parathyroid hormone and phosphate within 18∼24 hours postoperatively. The serum levels of ionized calcium were measured immediately and within 18∼24 hours postoperatively. We also determined the cut-off value, sensitivity and specificity of serum levels of parathyroid hormone, ionized calcium, and phosphate with a predictive value for the occurrence of clinical hypocalcemia. Results: Serum levels of parathyroid hormone were 2.0±1.7 pg/ml in the clinical hypocalcemia group, 9.9±10.7 pg/ml in the asymptomatic hypocalcemia group, and 15.3±10.7 pg/ml in the normal control group (P<0.001). Serum levels of ionized calcium were also significantly lower in the clinical hypocalcemia group (0.92±0.16 mmol/L) compared with the normal control group (P=0.002). On the other hand, serum levels of phosphate were significantly higher in the clinical hypocalcemia group (P=0.009). The cut-off value of serum parathyroid hormone levels for the prediction of clinical hypocalcemia was 4.5 pg/ml, where the sensitivity, specificity, positive predictive value, and negative predictive value were 87.5%, 63.4%, 89.3% and 59%, respectively. Conclusion: Serum parathyroid hormone levels following total thyroidectomy are the most powerful predictive factors for the occurrence of clinical hypocalcemia. Our results show that the incidence of clinical hypocalcemia is relatively higher at postoperative serum levels of parathyroid hormone ≤4.5 pg/ml.

부갑상선 증식증의 수술적 치료 경험

정파종,이국현,김한준,Pa Jong Jung,M,D,Kuk Hyun Lee,M,D,and Han Joon Kim,M,D 대한갑상선-내분비외과학회 2003 The Koreran journal of Endocrine Surgery Vol.3 No.1

Parathyroid hyperplasia is a pathologic finding that can be found in hyperparathyroidism. Unlike parathyroid adenoma, treatment of parathyroid hyperplasia is still quite controversial. In addition, the relative merits of two alternative surgical approaches-subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation have not been clearyly elucidated. The records of 10 patients who had parathyroid hyperplaisa and who underwent parathyroid surgery at the Department of Surgery, Hanyang University Hospital, between April 1992 and April 2003 were retrospectively reviewed. The 10 patients were comprised of 3 males and 7 females. The age distribution was between 29 and 73 years. The presenting clinical manifestations were associated with bone pain in 8 patients, muscle weakness in 4, headache in 4, gastrointestinal symptoms in 3, renal symptoms in 3 and psychologic symptoms in 2. The serum parathyroid hormone level was elevated in all patients. The serum alkaline phosphatase level was elevated in seven among the ten patients. Histopathologic findings revealed chief cell hyperplasia in all patients. Postoperative transient hypocalcemia occurred in 5 patients and they were supplied with oral calcium and calcitriol for several months. There were no major complications. The results indicate that a subtotal parathyroidectomy can be performed without mortality or morbidity and provides good control of primary parathyroid hyperplasia, A total prathyroidectomy with autotransplantation can be performed without mortality or morbidity and provides good contril of secondary and tertiary parathyroid hyperplaisa. (Korean J Endocrine Surg 2003; 3:26-31)

갑상선 전절제술 332예에 대한 임상적 고찰

전해명,성상욱,서영진,성기영,김정수,오세정,김승남,전정수,이재학,Hae Myung Jeon,Sang Wook Sung,Young Jin Suh,Ki Young Sung,Jeong Soo Kim,Se Jung Oh,Seung Nam Kim,Chung Soo Chun,and Jai Hak Lee 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.1

부갑상선 기능 보존 갑상선 전절제술 쥐 모델의 개발과 관리

박지웅,박경식,윤익진,최용범,조재훈 한국실험동물학회 2013 한국실험동물학회 학술발표대회 논문집 Vol.2013 No.8