갑상선 전절제술 후 발생한 일과성 부갑상선기능저하증 환자 군에서 조기 회복 군의 임상특징

오은미,정유승,류정원,이영돈,Eun Mee Oh,Yoo Seung Chung,Jungwon Ryu,Young Don Lee 대한갑상선-내분비외과학회 2014 The Koreran journal of Endocrine Surgery Vol.14 No.3

Purpose: Several reports have examined the predictors of temporary hypoparathyroidism after total thyroidectomy; however, few have assessed the clinical predictors of early recovery from the condition. Here, we compared the clinical factors of early and late recovery groups of patients with temporary hypoparathyroidism.Methods: The electronic medical records of 248 patients who underwent total thyroi-dectomy from January 2012 to July 2013 and had parathyroid hormone (PTH) levels <10 pg/mL on the first postoperative day were examined retrospectively. The early recovery group showed recovery from PTH at two weeks postoperatively and the late recovery group showed recovery from PTH at one month postoperatively.Results: The early recovery group included a lower proportion of males (8.6% vs. 23.7%, P<0.01) and a higher proportion of patients with more than three parathyroid glands saved (83.8% vs. 76.8%, P<0.04). There were no significant differences in the other variables examined.Conclusion: The early recovery group of patients with temporary hypoparathyroidism included a lower proportion of males and a higher proportion of patients with more than three parathyroid glands saved intraoperatively. These findings can be used as clinical indicators when discharge medication is prescribed.

부갑상샘종 및 부갑상샘 암에 대비되는 비정형 부갑상샘종의 임상병리학적 특성

오은미 ( Eun Mee Oh ),이규언 ( Kyu Eun Lee ),김수진 ( Su Jin Kim ),윤여규 ( Yeo Kyu Youn ),박귀원 ( Kwi Won Park ),오승근 ( Seung Keun Oh ),정경천 ( Kyeong Cheon Jung ),김영태 ( Young Tae Kim ),김광현 ( Kwang Hyun Kim ) 대한임상종양학회 2010 Korean Journal of Clinical Oncology Vol.6 No.2

목적: 일차성 부갑상샘항진증을 일으키는 질환인 부갑상샘종, 비정형 부갑상샘종, 부갑상샘 암 에 대하여 임상병리학적 특징을 후향적으로 분석해보고 특히 비정형 부갑상샘종의 특징에 대하여 알아보고자 하였다. 대상 및 방법: 1993년 1월부터 2008년 12월까지 서울대학교병원에서 일차성 부갑상샘항진증으로 부갑상샘 절제술을 시행한 88명의 부갑상샘종 환자와 10명의 비정형 부갑상샘종 환자, 2명의 부갑상샘 암 환자의 의무기록을 후향적으로 분석하였다. 결과: 비정형 부갑상샘종 군은 남녀 비율이 동일한데에 비하여 부갑상샘종은 여성에서, 부갑상샘 암은 남성에서 호발하였다. 비전형 부갑상생종 군과 부갑상샘종 군의 평균연령은 비슷하였으나 부갑상샘 암 환자는 두 군에 비하여 낮았다 (PA: 50.18±15.07yrs, AA: 49.1±13.76yrs, PC: 44.0±18.39yrs, p= 0.832.) 술전 시행한 혈청 칼슘 (PA: 11.90±1.46mg/dl, AA: 11.96±1.48mg/dl, PC: 14.25±2.76mg/dl, p= 0.091), 이온화 칼슘 (PA: 1.57±0.21mg/dl, AA: 1.54±0.34mg/dl, PC: 2.27mg/dl, p= 0.008)에서는 비전형 부갑상샘종 군과 부갑상샘종 군이 비슷하고 부갑상샘암 환자 군은 더 높았다. 술전 부갑상샘호르몬은 부갑상샘 암 환자에서 가장 높았고 비전형 부갑생종, 부갑상샘종 환자 순으로 높게 측정되었다. (335.30±465.40pg/ml, AA: 992.88±612.30pg/ml, PC: 1221.00±227.69pg/ml, p< 0.001) 부갑상샘 암 군은 술전 임상증상이 모두 나타났으며 비전형 부갑상샘종 군과 부갑상샘종 환자 군은 증상이 없이 발견된 경우가 많았다. 병변의 크기와 무게는 부갑상샘 암 군에서 가장 높았으며 비전형 부갑상샘종, 부갑상샘종군이 뒤를 이었다. 결론: 비정형 부갑상샘종은 임상병리학적 특성 상 부갑상샘종과 부갑상샘 암의 중간단계에 위치한다고 할 수 있으며 이에 수술 후 면밀한 추적관찰이 필요하다고 할 수 있다. Purpose: The causes of primary hyperparathyroidism include parathyroid adenoma(PA), atypical parathyroid adenoma(AA) and parathyroid carcinoma(PC). This retrospective study aimed to find the clinicopathologic characteristics among these three diseases and unique characteristics of AA. Patients and Methods: One hundred patients who underwent parathyroidectomy due to primary hyperparathyroidism from January 1993 to December 2008 in Seoul National University Hospital were enrolled. The electronic medical records of 88 patients of PA, 10 patients of AA and 2 patients of PC were analyzed retrospectively. Results: Male to female ratio was same in AA group but female predominance was found in PA group and male predominance in PC group. The mean age of AA group was similar to PA group but PC group was younger than other groups (PA: 50.18±15.07yrs, AA: 49.1±13.76yrs, PC: 44.0±18.39yrs, p= 0.832). The patients with PC showed higher preoperative serum calcium (PA: 11.90±1.46mg/dl, AA: 11.96±1.48mg/dl, PC: 14.25±2.76mg/dl, p= 0.091), ionized calcium (PA: 1.57±0.21mg/dl, AA: 1.54±0.34mg/dl, PC: 2.27mg/dl, p= 0.008) than other two groups and PA and AA showed similar results. PC group showed high parathyroid hormone levels than those of AA and PA (PA: 335.30±465.40pg/ml, AA: 992.88±612.30pg/ml, PC: 1221.00±227.69pg/ml, p< 0.001). Clinical symptoms were found more in PC group and majority of other two groups were found asymptomatic. PC group measured heavier and larger than AA and PA. Conclusion: AA might be an intermediate stage between PA and PC. Close follow up might be needed after operation for AA.

중독성 갑상선 결절의 치료에 있어서 수술적 치료의 중요성

박귀숙,오은미,송원종,이영돈,정유승,Guisuk Park,Eun Mee Oh,Won Jong Song,Young Don Lee,Yoo Seung Chung 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.3

Purpose: Autonomous hyperfunctioning thyroid nodules produce thyroid hormone independently of TSH. Of these, toxic thyroid nodules provoke hyperthyroidism and can be treated by surgery or radioactive iodine therapy. The aim of this study was evaluating the role of each treatment method in Korean patients with toxic thyroid nodule. Methods: From July 2008 to June 2013, 10 patients were diagnosed with toxic thyroid nodule. We diagnosed toxic thyroid nodule by thyroid function test and thyroid scan. Thyroid function test showed hyperthyroidism. Hot nodule and suppressed uptake surrounding thyroid tissue was observed on thyroid scan. We analyzed medical records of 10 patients retrospectively. Results: 9 patients were women and 1 patient was man. Median follow-up duration was 22 months. Most common symptom was neck mass (80%) and the median tumor size was 2.66 cm. 99mTc uptake increased by 6.41% on thyroid scan. All 10 patients refused radioactive iodine therapy and 3 of these denied even operation. In 7 patients underwent thyroidectomy, 4 patients were proved having thyroid malignancy (3 papillary thyroid carcinomas and 1 follicular thyroid carcinoma). Conclusion: In Korean patients, toxic thyroid nodule was likely to accompany thyroid malignancy and radioactive iodine therapy is contraindicated in this case. Therefore, we suggested that surgery has to be considered in the first place in treatment of toxic thyroid nodule.

일차성, 이차성 그리고 삼차성 부갑상선 기능 항진증 환자의 수술 후 임상결과: 서울대학교 병원에서의 14년 경험

최윤석 ( Yun Suk Choi ),이규언 ( Kyu Eun Lee ),박귀원 ( Kwi Won Park ),노동영 ( Dong Young Noh ),오은미 ( Eun Mee Oh ),최준영 ( June Young Choi ),윤여규 ( Yeo Kyu Youn ),오승근 ( Seung Keun Oh ),구도훈 ( Do Hoon Koo ) 대한임상종양학회 2011 Korean Journal of Clinical Oncology Vol.7 No.1

목적: 일차성, 이차성, 삼차성 부갑상선 기능 항진증은 각각 원인과 치료방법 그리고 임상 경과가 서로 다르지만 부갑상선 절제술이 표준치료로 알려져 있다. 본 연구에서는 각각의 부갑상선 항진증의 수술 전후의 임상적 변화를 알아보고 부갑상선 절제술의 의미를 재고 해보고자 하였다. 방법: 1996년부터 2009년까지 총 126명이 서울대학교 병원에서 부갑상선 절제술을 시행 받았으며 각각 일차성 96명, 이차성 24명, 삼차성 6명이었다. 환자들의 나이, 성별, 생화학적 검사, 수술방법, 병리학적 검사 결과를 전자 의무기록을 통해 후향적으로 분석하였다. 결과: 모든 세 군의 환자에서 혈청 칼슘, 부갑상선 호르몬, 이온화 칼슘이 수술 전보다 호전을 보였다. 이차성 환자군은 다른 두 군에 비해 수술 전, 후의 부갑상선 호르몬이 높았으며(p<0.001, p=0.036), 수술 후 지속적인 부갑상선 기능 항진증(30.4%) 및 일과성 저칼슘혈증(87.5%)도 다른 두 군에 비해 많이 발생하였다.(p< 0.001) 일과성 저칼슘혈증의 대부분(90.4%) 은 6개월 이내 회복 되었다. 이차성 환자에서 부갑상선 아전 및 전 절제술을 시행 받은 경우 수술 후 일과성 저칼슘혈증이 많이 나타났으나(71.4%), 제한적 절제술을 시행 받은 경우 지속적 부갑상선 기능항진증이 더 많이 나타났다.(50%) 결론: 부갑상선 절제술은 생화학 검사상의 호전을 위한 치료 방법으로 추천될 수 있으며, 이차성에서는 제한적 절제를 하는 경우 지속적 부갑상선 항진증의 빈도가 더 높으므로 부갑상선 아전 및 전 절제술을 시행해야 한다. Purpose: Primary hyperparathyroidism(PHPT), secondary hyperparathyroidism(SHPT) and tertiary hyperparathyroidism(THPT) are different in the cause, treatment and prognosis. However the parathyroidectomy has been an efficient treatment in all hyperparathyroidism groups. A single institution`s 14 year experience of surgical treatment was analyzed to investigate perioperative changes of clinical characteristics and reconsider the value of parathyroidectomy as the treatment option. Materials and Methods: From 1996 to 2009, 126 patients underwent parathyroidectomy at single institute and the number of patients with PHPT, SHPT and THPT were 96, 24 and 6 retrospectively. The electronic medical records of age, sex, biochemical analysis, operative method, and pathologic results were reviewed retrospectively. Results: Postoperative calcium (Ca), parathyroid hormone (PTH), ionized calcium (iCa) levels were improved definitely than preoperative Ca, PTH, iCa level in all three groups. Pre and postoperative PTH level in SHPT was higher than in PHPT and THPT(p<0.001, p=0.036) and postoperative persistent PTH increased status were more common in SHPT.(30.4%, p<0.001) Postoperative temporary hypocalcemia was more common in SHPT(87.5%, p<0.001), almost of them (90.4%) were recovered in 6 month. In SHPT group, temporary hypocalcemia were more common in subtotal or total parathyroidectomy group than in limited resection group (94.1%) but persistent iPTH increase were more common in limited resection group (50%). . Conclusion: Parathyroidectomy is highly recommended to improve biochemical laboratory findings in patients with hyperparathyroidism. And in SHPT, subtotal or total parathyroidectomy is more appropriate surgical method for reducing the high incidence of persistent hyperparathyroidism.