분화 갑상선암에서 전이평가를 위한 방사성 옥소 전신스캔과 혈청 갑상선글로부린 측정의 의의

노흥규,주원찬,김윤,한희정,원진호,채수홍,김현진,김도희,송민호 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

We retrospectively evaluated serum thyroglobulin and ^131I whole body scan of welldifferentiated thyroid carcinoma patients after total thyroid ablation by surgery and ^131I therapy. Serum thyroglobulin levels are highest in diffuse lung uptake(n=2, 2909.50±360.0ng/ml), regional lymph node uptake(n=12, 208.15±351.0ng/ml), remnant thyroid uptake(n=13, 19.53±25. 70ng/ml) and lowest in no active radioiodine uptake(n=4, 2.55±1.82ng/ml). We concluded that serum thyroglobulin and ^131I whole body scan were useful methods for assessing metastases and necessary in follow up of well-differentiated thyroid carcinoma. In cases of low serum thyroglobulin level and abnormal radioiodine uptake in ^131I whole body scan, thyroglobulin mRNA RT-PCR should be measured to assessing residual thyroid tissue and recurrence of well differentiated thyroid carcinoma. Thallium, ^99mTc-tetrofosmin, and fluorodeoxyglucose proton emission scans were known to more sensitive than ^131I whole body scan to detecting recurrence of well differentiated thyroid carcinoma. Patients with high serum thyroglobulin level and negative ^131I whole body scan, should be performed sensitive scintigraphies to reduce over-treatment of well differentiated thyroid carcinoma with high dose ^131I therapy.

분화성 갑상선암과 공존한 부갑상선 선종

이준호(Joon Ho Lee),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.2

It has become evident in recent years that parathyroid adenoma and well differentiated thyroid cancer occur together more than would be expected by chance alone. However, the association between them is not well understood. We have experienced 4 cases of coexistent parathyroid adenoma and well-differentiated thyroid cancer during the past 16 years. None of them had a familial incidence or a history of radiation exposure. Three cases showed symptomatic hypercalcemia(including renal stones, bone pain, joint pain) and in two of them(patient 1 and patient 2), thyroid abnormalities were detected preoperatively by neck ultrasonography or neck CT for evaluation of parathyroid lesions. However, in patient 3, a parathyoid humor was identified and removed incidentally during the course of thyroidectomy. In 3 cases, surgeries for thyroid carcinoma and parathyroid adenoma were performed during the same exploration of the neck, but in patient 4, thyroidectomy preceded parathyroidectomy; The interval between thyroidectomy and subsequent parathyroidectomy was 11 yeras. The thyroid tumors in 3 cases were papillary carcinoma, the sizes of which ranged from 1.0 cm to 1.5 cm in greatest diameter. The remaining case(patient 4) was minimal invasive follicular carcinoma. Total or near-total thyroidectomy with various types of cervical lymphnode dissection and bilateral neck exploration for the parathyroid lesion was performed in 3 cases with papillary carcinoma. Ipsilateral lobectomy and contralateral partial thyroidectomy with consequent unilateral neck exploration for the parathyroid tumor was performed in the case of follicular cancer. In our experience, parathyroid adenoma and well-differentiated thyroid carcinomas can be coexistent and we felt that the attention to the hypercalcemic patients would be needed for detection of this rare condition.

Increased Risk of Differentiated Thyroid Carcinoma with Combined Effects of Homologous Recombination Repair Gene Polymorphisms in an Iranian Population

Fayaz, Shima,Karimmirza, Maryam,Tanhaei, Shokoofeh,Fathi, Mozhde,Torbati, Peyman Mohammadi,Fard-Esfahani, Pezhman Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.11

Homologous recombination (HR) repair has a crucial role to play in the prevention of chromosomal instability, and it is clear that defects in some HR repair genes are associated with many cancers. To evaluate the potential effect of some HR repair gene polymorphisms with differentiated thyroid carcinoma (DTC), we assessed Rad51 (135G>C), Rad52 (2259C>T), XRCC2 (R188H) and XRCC3 (T241M) polymorphisms in Iranian DTC patients and cancer-free controls. In addition, haplotype analysis and gene combination assessment were carried out. Genotyping of Rad51 (135G>C), Rad52 (2259C>T) and XRCC3 (T241M) polymorphisms was determined by PCR-RFLP and PCR-HRM analysis was carried out to evaluate XRCC2 (R188H). Separately, Rad51, Rad52 and XRCC2 polymorphisms were not shown to be more significant in patients when compared to controls in crude, sex-adjusted and age-adjusted form. However, results indicated a significant difference in XRCC3 genotypes for patients when compared to controls (p value: 0.035). The GCTG haplotype demonstrated a significant difference (p value: 0.047). When compared to the wild type, the combined variant form of Rad52/XRCC2/XRCC3 revealed an elevated risk of DTC (p value: 0.007). It is recommended that Rad52 2259C>T, XRCC2 R188H and XRCC3 T241M polymorphisms should be simultaneously considered as contributing to a polygenic risk of differentiated thyroid carcinoma.

갑상선 유두암 환자에서 흉막 전이를 통한 흉수의 예

김주영,박대원,나진오,황병연,김동림,신동현,김신곤,최경묵,백세현,최동섭,조성진,김난희 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.2

Papillary thyroid carcinomas comprise approximately 80 percent of all thyroid cancers, but haves a good prognosis, with overall survival rates at 10 years of about 80 to 95 percent. They spreads through the lymphatic system, and the lung is the most frequent metastasis site. If distant metastasis is present, the overall survival rate is about 40 percent. Although malignant pleural effusion, with pleural metastasis is a rare complication in patients with papillary thyroid carcinoma, the development of malignant pleural effusion is an extremely adverse prognostic indicator. We recently experienced a case of malignant pleural effusion with papillary thyroid carcinoma. A 54-year-old woman was admitted to the hospital because of dyspnea. A chest X-ray showed massive pleural effusion in the right hemithorax. Previously total thyroidectomy, and iodine-131 therapy had been performed, but a local recurrence and pulmonary metastasis developed 5 years later, accompanied by malignant pleural effusion with pleural metastasis. We performed diagnostic thoracentesis, which confirmed a metastatic papillary thyroid carcinoma. This patient was a rare case of paplillary thyroid carcinoma, in which the disease was represented by a rapid deterioration with malignant pleural effusion. So we report this case with a review of the literature

Submucosal Esophageal Metastasis in a Patient with Poorly Differentiated Thyroid Carcinoma: a Case Report

김미진,김철승,박영삼,최은혜,한규담 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.3

We report an unusual case of esophageal metastasis protruding through the submucosa from a poorly differentiated thyroid carcinoma (PDTC). A PDTC is a very rare thyroid carcinoma subtype. A 68-year-old woman with PDTC exhibited recurrence at the thyroidectomy site and esophageal metastatic mass despite finishing the first treatment and undergoing regular follow-up. She received additional resective treatment with modified radical neck dissection for the recurrent neck nodes and endoscopic submucosal resection for the esophageal protruding mass. To our knowledge, no case of esophageal metastasis protruding through the submucosa from a PDTC has been previously reported.

Submucosal Esophageal Metastasis in a Patient with Poorly Differentiated Thyroid Carcinoma:

Mi Jin Kim,Cheol Seung Kim,Young Sam Park,Eun Hye Choi,Kyu Dam Han 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.3

We report an unusual case of esophageal metastasis protruding through the submucosa from a poorly differentiated thyroid carcinoma (PDTC). A PDTC is a very rare thyroid carcinoma subtype. A 68-year-old woman with PDTC exhibited recurrence at the thyroidectomy site and esophageal metastatic mass despite finishing the first treatment and undergoing regular follow-up. She received additional resective treatment with modified radical neck dissection for the recurrent neck nodes and endoscopic submucosal resection for the esophageal protruding mass. To our knowledge, no case of esophageal metastasis protruding through the submucosa from a PDTC has been previously reported.

대한갑상선학회 갑상선분화암 진료권고안; Part I. 갑상선분화암의 초기치료 - 제7장 갑상선분화암에서 수술 후 추가적인 외부 방사선조사나 항암 치료의 역할 2024

문신제 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

Surgical resection is typically the primary treatment for differentiated thyroid cancer (DTC), followed by radioactive iodine (RAI) and thyroid-stimulating hormone suppression therapies based on the cancer stage and risk of recurrence. Nevertheless, further treatment may be necessary for patients exhibiting persistent disease following RAI therapy, residual disease refractory to RAI, or unresectable locoregional lesions. This guideline discusses the role of external beam radiotherapy and chemotherapy following surgical resection in patients with DTC. External beam radiotherapy is ineffective if DTC has been entirely excised (Grade 2). Adjuvant external beam radiotherapy may be optionally performed in patients with incomplete surgical resection or frequently recurrent disease (Grade 2). In patients at high risk of recurrence following surgery and RAI therapy, adjuvant external beam radiotherapy may be optionally considered (Grade 3). However, external beam radiotherapy may increase the risk of serious adverse events after tyrosine kinase inhibitor therapy. Therefore, careful consideration is needed when prescribing external beam radiotherapy for patients planning to undergo tyrosine kinase inhibitor therapy. There is no evidence supporting the benefits of the routine use of adjuvant chemotherapy for DTC treatment (Grade 2).

대한갑상선학회 갑상선분화암 진료권고안; Part III. 진행성 갑상선분화암의 치료 - 제5장 진행성 갑상선분화암 전이 병소의 부위별 치료 원칙 2024

정경연 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

Only a small percentage of patients (2-5%) with differentiated thyroid cancer (DTC) exhibit distant metastasis at the initial diagnosis or during the disease course. The most common metastatic sites of DTC are the lungs, followed by the bones. Radioactive iodine (RAI) therapy is considered the primary treatment for RAI-avid distant metastatic DTC. Depending on the characteristics of metastatic lesions, local treatment such as surgical resection, radiofrequency ablation, and external beam radiation therapy may be considered for some patients with metastatic DTC. Slowly growing and asymptomatic metastases can be monitored with follow-up while receiving thyroid-stimulating hormone (TSH) suppression therapy. In patients with a limited number of lung metastases and good performance status, surgical removal of the metastatic lesions may be considered. Systemic therapy should be considered for patients with progressive RAI refractory DTC. In this clinical guideline, we aim to outline the treatment principles for patients with lung, bone, and brain metastases of DTC.

갑상선 결절 환자에서 혈청 갑상선자극호르몬 수치와 고분화 갑상선암과의 연관성에 관한 분석

정성엽,김훈엽,류우상,우상욱,손길수,이재복,배정원,Sung Yup Joung,Hoon Yub Kim,Woo Sang Ryu,Sang Uk Woo,Gil Soo Son,Jae Bok Lee and Jeoung Won Bae 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.4

Purpose: This study investigated the effects of serum thyroid-stimulating hormone (TSH) levels in predicting malignancy-associated differentiated thyroid cancer (DTC) and benign thyroid nodules. Methods: Between January 2005 and December 2007, 346 patients underwent thyroid surgery at one hospital. Their records were retrospectively reviewed. Results: Sixty-nine percent (237 of 346) of the patients had DTC. The mean preoperative TSH level was higher than in the malignant group (5 uIU/ml vs 0.4 uIU/ml). The rate of malignancy was the 71% in patients with TSH levels >5 uIU/ml. The TSH level of DTC with metastasis of the lymph node was higher than that with non-metastasis (3.08 uIU/ml vs 2.09 uIU/ml, P<0.01) Conclusion: The likelihood of DTC increases with higher serum TSH concentration. Serum TSH level might be useful in predicting malignant nodular thyroid lesion. (Korean J Endocrine Surg 2010;10:220-223)

편측 갑상선 절제술을 시행받은 분화 갑상선암 환장에서 Completion Thyroidectomy의 소견

김은숙,고정민,김원배,홍석준,송영기 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: 수술 전 갑상선암의 세포진단이 없거나 세포검사상 악성이 분명하지 않은 환자들 중 수술 후 갑상선암이 발견되는 경우가 있는데, 이런 갑상선암 환자에서 completion thyroidectomy 조직에서 종양의 존재에 대한 예측인자를 알아보고자 하였다. 방법: 1995년 5월부터 2001년 12월까지 서울아산병원에서 세포검사상 갑상선암이 확진되지 않은 상태에서 갑상선엽 절제술 및 협부절제술을 시행받은 환자중, 조직검사상 분화된 갑상선암이 발견되어 completion thyroidectomy를 시행받은 환자 65명을 대상으로 하였다. 연령분포는 14세에서 71세(평균 39.8±12.4세)였으며, 남자 12예, 여자 53예였다. 환자들의 임상상 및 1차 수술 시의 조직 병리 소견을 기준으로 2차 수술 시 반대쪽 갑상선엽에 종양이 존재할 위험 인자를 분석하였다. 결과: 대상환자 65명의 첫 수술시 조직유형은 여포선암 45예, 유두선암 18예, 수질암 1예, insular carcinoma 1예였다. 종양의 평균 크기는 4.0±1.8㎝(범위, 0.3∼8.5㎝)이었으며, 결절의 수는 단일결절 38예, 다결절 27예였다. 국소 림프절 전이는 1예, 갑상선피막 침범소견은 4예에서 보였다. 또 전체 65예 중 27예에서 다발성으로 종양이 관찰되었다. Completion thyroidectomy 조직에서는 65예 중 22예(33.8%)에서 종양이 관찰되었다. 조직유형으로는 첫 수술에서 여포선암으로 진단된 45예 중 14예에서, 유두선암으로 진단된 18예 중 8예 종양이 발견되었다. 반대편 갑상선엽에 종양이 발견되었던 군과 그렇지 않은 군 사이에 성별, 나이, 첫 수술시의 종양의 최대크기, 종양의 세포형 등은 차이가 없었으나 첫 수술에서 종양의 다발성 유무와는 유의한 상관관계가 있었다. 결론: 편측 갑상선 절제술을 시행 받은 환자에서 갑상선암으로 진단되는 경우 종양의 다발성 유무가 completion thyroidectomy시 반대편 갑상선엽의 종양 여부를 예측할 수 있는 유일한 인자이며, 이런 경우 completion thyroidectomy의 시행이 필수적으로 생각된다. Background: In some instance, thyroid cancer may be diagnosed only after resection of a putative or suspected benign nodule. In theses cases a complete thyroidectomy is usually recommended to prevent recurrence. We analyzed the frequency of malignancy in the contralateral lobe after a complete thyroidectomy, and assessed the factors that may predict the presences of a malignancy, which might necessitate a complete thyroidectomy. Methods: Between 1995 and 2001, 65 patients, who initially underwent a lobectomy and isthrnectomy, but were finally diagnose with differentiated thyroid carcinoma, underwent complete thyroidectomies. Their mean age was 39.8±12.4 years, ranging, 14 to 71 years. After initial surgery, 45 proved to have follicular carcinomas, 18 papillary carcinomas, 1 medullary and 1 insular carcinoma. The mean tumor size was 4.0±1.8㎝, ranging from 0.3 to 8.5㎝. After a complete thyroidectomy, the presence of a tumor the at contralateral lobe was assessed according to clinical parameters and the pathological findings in the ipsilateral lobe. Results: The first surgeries revealed tumor multifocality in 27 cases, perithyroidal tumor extension in 4 and lymph node metastasis in 1. On completion of the thyroidectomy, 22 of the 65 patients had a malignancy in the contralateral lobe. Age, sex, size or the pathological primary tumor type, were not associated with the presence of additional tumors at the contralateral lobe. Tumor multifocality at the first surgery was the only significant variable to predict the presence of a tumor in the contralaeral lobe. Conclusion: When thyroid cancer is diagnosed after ipsilateral surgery, the only predictive factor for the presence of a contralateral tumor was multifocality. We believe that a complete thyroidectomy is mandatory in these cases (J Kor Soc Endocrinol 17:657∼663, 2002).