Tc-99m Sestamibi Scintigraphy를 이용한 부갑상선과 갑상선 결절의 감별진단

서승원<SUP>1<,SUP>,주재균<SUP>1<,SUP>,윤정한<SUP>1<,SUP>,제갈영종<SUP>1<,SUP>,범희승<SUP>2<,SUP>,Seung Won Seo,M,D,<SUP>1<,SUP>,Jae Kyun Joo,M,D,<SUP>1<,SUP>,Jung Han Yoon,M,D,<SUP>1<,SUP>,Young Jong Jaegal,M,D,<SUP> 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.1

Purpose: Differentiation of parathyroid and thyroid nodule is often difficult even with aids of ultrasonography and computed tomography. Tc-9m sestamibi (MIBI) scintigraphy is useful in the detection of hyperfuntioning parathyroid nodules. However, its role in the differentiation between parathyroid and thyroid nodules including malignancies is not well studied. Therefore, the purpose of this study is to evlauate the role of Tc-99m MIBI imaing in the differentiation of parathyroid adenoma from thyroid malignancy. Methods: Six patients (4 women, 2 men, mean age 43 years) with parathyroid adenoma and 4 patients (2 women, 2 men, mean age 56 years) with thyroid papillary cancer were enrolled. Ten and 180 minutes after injection of 740 MBq Tc-99m MIBI, pinhole image of the anterior neck was obtained. Nodule-to-thyroid ratio (N:T) was measured from same sized region of interests over nodule and normal thyroid bed. Retention Index (RI) was calculated as N:T 10 minus N:T 180 divided by N:T 10. Results: Patients with parathyroid adenoma showed similar N:T 10 as those with thyroid cancer (1.09 ⁢/⁣ 0.35, 1.24⁢/⁣ 0.36, respectively, P>0.05 ). However, RI of parathyroid patients was higher than thyroid cancer patients (0.64 ⁢/⁣ 0.29, ⁣0.12⁢/⁣ 0.20, respectively, P<0.05). Conclusion: Parathyroid adenoma showed higher retention rate of Tc-99m MIBI than thyroid cancer. Therefore, differntiation of parathyroid and thyroid nodule could be possible using Tc-99m MIBI scintigraphy. (Korean J Endocrine Surg 2002;2:15-18)

갑상선 결절에 동반된 퇴행성 낭종의 재발과 낭액내 VEGF의 관련성

조은호,박희붕,김현만<SUP>1<.SUP>,이관우<SUP>1<.SUP>,정윤석<SUP>1<.SUP>,소의영,Eun Ho Cho,M.D.,Hee Boong Park,K.D.,Hyun Man Kim,M.D.<SUP>1<.SUP>,Kwan Woo Lee,M.D.<SUP>1<.SUP>,Yun Suk Jung,M.D.<SUP>1<.SUP> and Euy Young 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.1

Purpose: VEGF, a potent angiogenic factor, increases vascular permeability and induces the fluid accumulation in the peritoneal and pleural cavities. This study is designed to know whether the VEGF concentration are associated with the formation of cystic fluid of thyroid nodules and the results of treatment. Methods: To know whether thyroid follicular cells produce VEGF, we measured the VEGF concentration in the conditioned medium after primary culture of the normal thyroid follicular cells (NT 1.0). Thirty seven patients, who had visited Ajou University Medical Center, were divided into two groups; group A (n=19) is patients whose cystic nodules disappeared completely with 1 or 2 times fine needle aspirations. In Group B (n=18), the cystic nodules recurred rapidly and required aspiration more than 3 times. Clinical records of patients were analyzed and compared with TSH and VEGF levels in cystic fluids. Results: The VEGF concentration in basal conditioned medium were 8.2⁑1.2 ng/ml in NT 1.0 and 8.2⁑0.6 ng/ml in thyroid cancer cell line (FTC-133). NT 1.0 was not affected by TSH stimulation. Mean concentration of TSH of all cystic fluids was 4.36μIU/ml (0.13∼21.7) and there was no difference between 2 groups. Mean concentration of VEGF of all cystic fluids was 140.7 ng/ml (11.1∼688.8). The VEGF concentration (287.9⁑289.6 ng/ml) in group B was significantly higher than that (104.2⁑97.1 ng/ml) in group A (P<0.05). Conclusion: This study suggests that thyroid follicular cells produce and secrete VEGF, and VEGF is related with the accumulation of cystic fluid in degenerative cysts of thyroid. Cysts with high VEGF concentration promote rapid reaccumulation of the cystic fluid and possibly necessitate operation in selected patients. (Korean J Endocrine Surg 2002;2:25- 30)

변형 근치 경부 림프절 절제술시 Iron-Intern 사용의 초기 경험

박융석<SUP>1<,SUP>,정승필<SUP>1<,SUP>,구민영<SUP>2<,SUP>,최준호<SUP>1<,SUP>,김정한<SUP>1<,SUP>,김지수<SUP>1<,SUP>,Yoong Seok Park<SUP>1<,SUP>,Seung Pil Jung<SUP>1<,SUP>,Min Young Koo<SUP>2<,SUP>,Jun-Ho Choe<SUP>1<,SUP> 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.1

Purpose: Modified radical neck dissections (MRND) in papillary thyroid cancer surgery usually leave a long incision in the neck, causing cosmetic problems. We introduce a new surgical approach to MRND, with minimal lateral extension of transverse collar incisions, using the Iron-Intern. Methods: Between Jan 2008 and Dec 2008, 135 patients with papillary thyroid cancer who had undergone MRND were enrolled in this study. Total thyroidectomy and central node dissection with Kocker transverse collar incision with minimal additional lateral extension were performed before MRND. MRND were performed including level II, III, IV and V. Among 135 patients, we performed MRND with the Iron-Intern in 70 patients (Group I) and 65 patients who had MRND performed without the Iron-Intern (Group II) were included as a control group. In Group I, the Iron-Intern, with some modifications, was applied during the dissection of the level II area. The postoperative outcomes of the patients were analyzed and compared retrospectively. Results: The median hospital stay was significantly lower in Group I compared to Group II (P=0.003). The median operation time was significantly higher in Group I than Group II (P=0.002). The median numbers of harvested central and lateral lymph nodes were 10, 29 (group I) and 8, 23 (group II), respectively (P=0.073, P=0.148). Median levothyroxine off thyroglobulin levels were 1.2 and 1.8 in Group I and II, respectively (P=0.110). Conclusion: MRND, with minimal lateral extension using the Iron-Intern, can be easily and safely performed, leaving only minor scars in the neck.

<SUP>18</SUP>F-FDG PET-CT에서 진단된 갑상선 우연종의 악성종양 발견율 및 특징

이강영,고건<SUP>1<.SUP>,김선국<SUP>1<.SUP>,고진철<SUP>1<.SUP>,김행수,최상용,박신희,박용휘<SUP>2<.SUP>,Kang Young Rhee,Gun Koh,<SUP>1<.SUP>,Sun Kuk Kim,<SUP>1<.SUP>,Jin Chul Koh,<SUP>1<.SUP>,Haeng Soo Kim,Sang Yong Choi,Shin 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.1

<B>Purpose: </B>PET-CT is often used to differentiate benign or malignant thyroid incidentalomas. In this retrospective study, we evaluated whether the <SUP>18</SUP>F-FDG uptake pattern and PET-CT findings improved accuracy over the standardized uptake value (SUV). <B>Methods:</B> <SUP>18</SUP>F-FDG PET-CT was performed on 2,178 subjects from August, 2004, to October, 2007, in Sung-ae Hospital. PET-CT was performed on 806 patients (37%) with suspected or known nonthyroidal cancer and 1,372 healthy subjects (63%) without a previous history of cancer. We investigated the clinical characteristics of patients, history, standardized uptake value (SUV), ultrasonography, and hormone levels in blood. Thyroidal cancer was confirmed by ultrasonography-guided fine needle aspiration and pathology after thyroid operation. <B>Results:</B> The prevalence of focal thyroid lesions on PET-CT was 8.8% (191/2178). Thyroid cancer confirmation was 7.9% (15/191). The maximum SUV of malignant thyroid lesions were significantly higher than that of benign lesions (7.00±3.08 vs. 4.49±1.84, P<0.001). <B>Conclusion:</B> PET-CT image interpretation that includes 18F-FDG uptake and SUV is better than PET-CT alone for differentiating benign and malignant lesions. Thyroid cancer risk increases as SUVmax levels increase. <B>(Ko</B><B></B><B>rean J Endocrine Surg 2008;8:38-42)</B>

갑상선 종양에서 Heat Shock Protein70과 Heat Shock Protein90의 발현 양상

최진욱,김진영,박철영<SUP>1<.SUP>,오기원<SUP>1<.SUP>,임성희<SUP>1<.SUP>,박성우<SUP>1<.SUP>,조현득<SUP>2<.SUP>,이명준<SUP>3<.SUP>,김이수,Jin Wook Choi,M.D.,Jin Yong Kim,Cheol Young Park,M.D.<SUP>1<.SUP>,Ki Won Oh,M.D.<SUP>1<.SUP> 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.2

Purpose: Heat shock proteins (hsps) are synthesized by cells in response to various stress conditions, including carcinogenesis. The expression of hsps in neoplasia has been implicated in the regulation of cell signaling pathway such as cell survival and apoptosis. This study aimed to determine whether hsps expression in various thyroid neoplasia are significant and to identify the possibility as a therapeutic molecular target. Methods: We examined the expression of the hsp70 and hsp90 on tissue section from 53 thyroid tissues (16 normal tissues; 11 nodular hyperplasia; 12 follicular adenomas; 14 papillary carcinomas) using immunohistochemistry. Hsps expression was scored according to the percentage of positively stained cells (grade 0 to grade III). Results: For hsp70, all of the 53 tissues showed over- expression. 100% (16/16) of normal thyroid tissue and 87.0% (20/23) of benign tissue were categorized as grade I or II. In comparison, the carcinoma tissues showed expression in 64.3% with grade III. For hsp90, almost of normal thyroid tissue and benign tumors showed no expression (87.5% in normal tissues, 91.3% in benign tumors). However, all of carcinoma tissues showed expression and 78.6% (11/14) of carcinoma were in grade II or III. Conclusion: In current study, the pattern of expression for hsp70 and hsp90 in normal, benign, malignant thyroid tissues suggests that heat shock proteins might have some role in tumorigenesis in thyroid. Since there have been no reports on heat shock proteins and thyroid, further study is necessary and could give us clinically significant clue for diagnosis and treatment. (Korean J Endocrine Surg 2004; 4:79-84)

갑상선 수술 후 음성 변화

홍종철,이형신<SUP>1<.SUP>,김성원<SUP>2<.SUP>,이강대<SUP>2<.SUP>,Jong-Chul Hong,Hyoung-Shin Lee,M.D.<SUP>1<.SUP>,Sung- Won Kim,M.D.<SUP>2<.SUP> and Kang-Dae Lee,M.D.<SUP>2<.SUP> 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.3

Purpose: Vocal symptoms have been reported after thyroidectomy and even in the absence of injury to the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve. The aim of this prospective study was to evaluate the subjective and objective voice changes in patients without laryngeal nerve injury after thyroidectomy. Methods: The subjects had undergone total thyroidectomy for differentiated thyroid carcinoma from November 2007 to December 2008. Twenty-eight subjects (males: 8, females: 20) were selected for this study. Voice analysis was prospectively evaluated in the subjects at the time of preoperation and postoperation (10.8 months for the males and 11.7 months for the females). A subjective analysis was done using the visual analogue scale (VAS, 0: no symptom, 10: severe symptoms) and objective analyses were determined by several parameters such as the fundamental frequency (Fo), jitter, shimmer and the noise to harmonic ratio (NHR) using the multi-dimensional voice program. Maximum phonation time (MPT)was performed as an aerodynamic test. Results: 3 patients (37.5%) among the males and 14 patients (70%) among the females had subjective postoperative voice change. The VAS showed a significant difference for the females (0 to 1.25±0.97, P<0.001), whereas no changes were shown for the males (0 to 0.88±1.25, P>0.05). The vocal parameters (Fo, jitter, shimmer, NHR) and MPT showed no significant changes for both the males and females (P>0.05). Conclusion: Subjective voice changes may occur after thyroidectomy without laryngeal nerve injury. Surgeons should take possible voice changes into consideration when informing patients before thyroidectomy. (Korean J Endocrine Surg 2011;11:175-178)

부신종으로 오인된 후복벽 기관지성 낭종 1예

장항석<SUP>1<,SUP>,박준성<SUP>2<,SUP>,정웅윤<SUP>2<,SUP>,박정수<SUP>2<,SUP>,Hang-Seok Chang,M,D,<SUP>1<,SUP>,Jun Sung Park,M,D,<SUP>2<,SUP>,Woung Youn Chung,M,D,<SUP>2<,SUP> and Cheong Soo Park,<SUP> <,SUP>M,D,<S 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.1

Bronchogenic cyst can be found about everywhere in the mediastinum and rarely in the abdomen. Embriologically, the bronchogenic cyst, one of the primitive foregut-derived developmental anomalies, is composed of any or all of the tissue elements seen in a bronchus including respiratory epithelium, smooth muscle, mixed serous and mucose glands and cartilage. Most bronchogenic cysts are asymptomatic. The diagnosis is therefore made either as an incidental finding or, more usually is secondary to other organic complications such as infection, hemorrhage, compression of adjacent organs. Only a few of subdiaphragmatic bronchogenic cyst have been reported and their occurrence in the retroperitonum is extremely rare. We present a case of retroperitoneal bronchogenic cyst presenting as adrenal tumor which was successfully treated by laparoscopic resection. (Korean J Endocrine Surg 2001;1:122-124)

갑상선 자극호르몬이 갑상선암세포의 VEGF, 신생혈관 형성, 성장, 침윤 및 전이에 미치는 영향

소의영,박희붕,김혜진,김현만<SUP>1<,SUP>,Euy Young Soh,M,D,Hee Boong Park,M,D,Hye Jin Kim,M,D,and Hyun Man Kim,M,D,<SUP>1<,SUP> 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.1

Purpose: Vascular endothelial growth factor (VEGF) is a vascular endothelial cell specific mitogen and a major regulator of angiogenesis. VEGF secretion is activated in some thyroid cancers and that VEGF secretion is stimulated by TSH. So we postulated that TSH may promote growth and invasion in some thyroid cancers by stimulating VEGF secretion and angiogenesis. Methods and Results: We investigated the TSH effect for the VEGF secretion, endothelial cell proliferation and invasion in vitro with the primary cultured normal thyroid cell (NT-1) and thyroid cancer cell line (TPC-1). And to evaluate the relationship between TSH and VEGF, angiogenesis and tumor growth in vivo, we xenografted human dermal matrix inoculated with thyroid cells into nude mice or directly injected subcutaneously. For the study, mice were made hypothyroid (Group 1) by antithyroid hormone p.o, hyperthyroid (Group 2) by L-thyroxine injection and euthyroid (Group 3). One week after the treatment, significant difference were noted in T3, T4 and TSH level between each group, but the VEGF level showed significant difference in group 1 only compared with group 2 and 3. NT-1 or TPC-1 were seeded in the upper chamber of Transwell and HUVEC were cultured in lower chamber, and added different concentration of TSH. NT-1 and TPC-1 secreted VEGF under basal condition, but the level were similar. TPC-1 cells secreted significantly more VEGF than NT-1 after TSH (1, 10, 100 mIU/dl) stimulation, which were also parallel with the concentration of TSH. In low concentration of TSH (0, 1 mIU/dl), there were no difference of HUVEC proliferation between NT-1 and TPC 1. In high concentration of TSH (10, 100 mIU/dl), however, TPC-1 enhanced HUVEC proliferation than NT-1 significantly (p<0.05). Similar findings were noted in thyroid cell invasion. Invasion was higher in TPC-1 than in NT-1 in high concentration of TSH (10, 100 mIU/dl). In vivo study using the dermal matrix showed that number of blood vessels ingrowth were higher in Group 1 (25/HPF) than Group 2 (16/HPF) or Group 3 (17/HPF). But there was no difference between Group 2 and Group 3. Level of TSH and VEGF were also increased significantly in Group 1 compared with in Group 2 and Group 3. The size of tumor did not showed significant difference between each group during observation. The tumor from Group 1 (6.2 gm) were larger compared with Group 2 (5.1 gm) or Group 3 (5.6 gm), but this difference was not significant statistically (p>0.05). The number of blood vessels in tumor were also more increased in Group 1 and were commonly located in the peripheral portion of tumor. Conclusion: We conclude that thyroid cancer cell line secrete the VEGF and TSH secretion is more enhanced by the stimulation of TSH. And increased VEGF promote the vascular endothelial cell proliferation, invasion and angiogenesis in thyroid cancer. (Korean J Endocrine Surg 2001; 1:51-60)

The Utility of Clinical Findings Including Serum TSH and Neck Ultrasonography for Predicting Thyroid Malignancy in Atypia of Undetermined Significance/Follicular Lesions of Undeter-mined Significance

Eun Mee Oh<SUP>1<,SUP>,Yoo Seung Chung<SUP>1<,SUP>,Won Jong Song<SUP>1<,SUP>,Yeun Sun Kim<SUP>2<,SUP>,Young Don Lee<SUP>1<,SUP> 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.3

Purpose: Neck ultrasonography (NUS) is one of the most commonly used methods for evaluating thyroid nodules and preoperative higher TSH levels are known to be associated with differentiated thyroid cancers. This study was conducted to assess whether serum TSH levels and neck ultrasonography are of value in predicting malignancy in patients with atypia of undetermined significance/follicular lesions of undetermined significance (AUS). Methods: A total of 62 patients (7 men, 55 women; mean age 48.4±11.9 years) who had indeterminate cytologic results indicating AUS underwent thyroidectomy. Preoperative clinical data including serum TSH and the findings of NUS were analyzed retrospectively between malignant and non-malignant groups. Results: The final pathologic results of malignancy were reported in 53 of 62 (85.5%) patients with AUS. There was no significant difference in the mean value of preoperative serum TSH between malignant and non-malignant groups (1.5±1.3 vs. 1.9±1.2, P=NS). In NUS, the patients diagnosed with malignancy in histology showed a higher proportion of calcification, taller-than-wide shape, hypoechoic texture and irregular margin (58.5% vs. 22.2%, P=0.044; 34% vs. 0%, P=0.038; 98.1% vs. 44.4%, P<0.01; 47.2% vs. 0%, P= 0.008). Conclusion: Serum TSH was not related to malignancy in thyroid nodules showing AUS. However, ultrasonographic features including calcifications, taller-than-wide shape, hypoechoic pattern and irregular margin could be used to predict malignancy. Ultra-sonography should be the first useful methods when making decisions regarding mana-gement of thyroid nodules showing indeterminate cytologic results as AUS.

수술 전 혈청 갑상선 자극 호르몬(TSH)수치와 갑상선 유두암과의 상관관계

송금종,한선욱,이진형<SUP>1<,SUP>,우희두<SUP>2<,SUP>,김성용,김재우<SUP>3<,SUP>,박래경<SUP>1<,SUP>,백무준,김창호,Geum Jong Song,M,D,Sun Wook Han,M,D,Jin-Hyung Lee,M,D,<SUP>1<,SUP>,Hee-Doo Woo,M,D,<SUP>2<,SUP>,Sung Yong Kim,M,D,Ph 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.3

Purpose: Recent research has shown that there is a relationship between the level of preoperative serum TSH and a papillary thyroid carcinoma. Therefore, this study examined the correlation between the serum TSH and papillary thyroid carcinoma. Methods: The preoperative serum TSH level of papillary thyroid carcinoma and nodular hyperplasia of 418 patients from 2009 Jan. to 2011 Dec. was examined. The patients were divided into 3 groups, nodular hyperplasia, less than 1 cm micropapillary carcinoma and more than 1 cm papillary carcinoma, and their TSH levels were compared. Results: Nodular hyperplasia and total papillary carcinoma was found in 98 (23.0%) and 322 (77.0%) patients, respectively. After dividing the patients according to the size of the mass, there were 224 (53.6%) patients with a mass less than 1 cm in size and 98 (23.4%) patients with a mass more than 1 cm in size. The preoperative serum TSH level of the 3 groups showed a significant difference, which was 1.180±1.168 ՌIU/ml in the nodular hyperplasia group, 1.670±1.224 ՌIU/ml in the micropapillary carcinoma group and 2.279±2.837 ՌIU/ml in the papillary carcinoma group (P<0.001). On the other hand, there were no significant correlations between the preoperative serum TSH level and gender, age, metastasis to lymph node, number of masses and extrathyroidal extensions. Conclusion: The larger size of the papillary thyroid carcinoma, the higher the preoperative high serum TSH level. Therefore, the stimulation of TSH can affect the progression of papillary thyroid carcinoma but more study will be needed.