수술을 필요로 하는 갑상선 양측성 양성결절에서 전절제술의 의의

안창남(Chang Nam Ahn),강경호(Kyung Ho Kang),김이수(Lee Su Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.6

Purpose: A total thyroidectomy for the treatment of bilateral thyroid benign nodules is still controversial. This study prospectively compared the prognosis and complications of a total thyroidectomy with those after a subtotal thyroidectomy. Methods: Between September 2003 and October 2006, a total of 110 consecutive patients with bilateral thyroid benign nodules underwent either a total (n=77) or subtotal thyroidectomy (n=33). Temporary or permanent hypoparathyroidism, temporary or permanent recurrent laryngeal nerve palsy, operation time, the length of hospital stay, postoperative thyroxine dosage in both operation groups were compared. In addition, the detection rate of a malignancy through a permanent biopsy was examined. Results: There was a higher rate of temporary hypoparathyroidism, longer length of hospital stay and higher thyroxine dosage needed in the total thyroidectomy group than in the subtotal thyroidectomy group. There were no significant differences in the permanent hypoparathyroidism, temporary or permanent recurrent laryngeal nerve palsy and operation time between the two groups. The histopathological diagnosis was a malignant tumor in 13 patients. Conclusion: This study suggests that a total thyroidecotmy can be performed without increasing risk of complications. A total thyroidectomy avoids recurrent nodules for the removal of the whole thyroid tissue, which avoids the need for secondary surgery with an increased risk of complications when compared with primary thyroid surgery. A total thyroidecotmy is considered the first choice for the management of bilateral thyroid benign nodules.

양성 갑상선 낭성 결절에서 에탄올 경화 요법의 결과

강기근,이준형,윤시원,박헌수,홍종철 대한이비인후과학회 부산,울산,경남 지부회 2015 임상이비인후과 Vol.26 No.1

Objectives:Ethanol injection under ultrasound guidance has been proposed as an alternative to surgery in the treatment of benign thyroid cysts. So we evaluated efficacy and safety of ultrasonography guided ethanol sclerotherapy for cystic thyroid nodules with analyzing results retrospectively. Methods:Between May 2010 and Jun 2012, 18 cystic thyroid nodule patients (19 cysts) were treated with ethanol ablation. We evaluated the treatment outcomes with the change of volume reduction and the improvement of symptomatic and cosmetic complains and complications. Results:Initial mean cystic nodule volume was 8.5 mL (range, 0.4-31 mL) and mean volume after ablation 1 week was 5.7 mL (range, 0.02-21 mL) in ultrasonography (p=0.154). Each of the mean volume at 1 month and 6 months after treatment was 2.9 mL (0-13 mL, p=0.002) and 0.8 mL (0-5.9 mL, p=0.000). The mean volume reduction rate was 90% (50-100%). Mean symptoms and cosmetic grading scores improved from 5 to 1.7 and from 3.5 to 1.5 (p=0.000). No significant complications were observed during the follow up. Conclusions:Percutaneous ethanol injection may prove a safe and effective tool for the therapy of the benign thyroid cysts.

외과의사에 의해 시행된 양성 갑상선 결절의 고주파 절제

오래영,최은혜,성치원,박영삼,김철승,한규담,Rae Young Oh,Eun Hye Choi,Chi Won Sung,Young Sam Park,Cheol Seung Kim and Kyu Dam Han 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.4

Purpose: The ability to apply radiofrequency ablation (RFA) has provided for a greater diversity of approaches for treatment of benign thyroid nodules. This study evaluated the efficacy and safety of RFA performed by a surgeon. Methods: From January 2009 to November 2010, a total of 47 benign thyroid nodules were treated with RFA performed by one surgeon. Nodular patterns were divided into mainly cystic, mixed, and mainly solid (soft solid, hard solid) nodules, and ultrasonography was performed for assessment of the volume-reduction radio (VRR) of each nodule. Follow-up ultrasonography was performed three to 19 months after ablation. And complication was observed. One session of RFA was performed. Results: The median volume before ablation was 7.8 cm<SUP>3</SUP> (range 1.3∼43.2 cm<SUP>3</SUP>). After ablation, the median volume was 0.9 cm<SUP>3</SUP> (range 0.0-21.6 cm<SUP>3</SUP>) and VRR was 81.5±17.3%. RFA in mainly cystic nodules resulted in significant decreases in VRR (93.7±5.0%, P=0.009). It was the largest among the nodular types. VRR was 81.4±13.1% in mixed nodules, 77.2±19.2% in mainly solid nodules, 85.9±11.0% in soft solid nodules, and 54.2±17.3% in hard solid nodules 95.7% of nodules (45 nodules) showed more than 50% reduction, while the two remaining nodules, which were hard solid nodules, showed less than 50% reduction. Complications included pain, voice change, nausea, and transient voice change. Conclusion: Results of this study demonstrated the safety and effectiveness of RFA performed by a surgeon for reducing nodule volume.

양성 갑상선 결절의 내과적 치료

이재복,Jae Bok Lee,M.D.,Ph.D. 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.1

Thyroid nodules are frequently diagnosed today, mainly due to the wide use of neck ultrasonography (US). The majority of these lesions are benign; suspicion for malignancy is an indication for surgery, while benign thyroid nodules may be managed conservatively. There is evidence that a large percentage of patients with thyroid nodules are over-treated. Careful and accurate identification of patients with thyroid nodules that are highly suspicious for an underlying malignancy would allow for a more reasonable therapeutic approach and would result in a reduction of the number of unnecessary thyroidectomies. Fine needle aspiration cytology is currently the most accurate and cost effective diagnostic approach for the evaluation of patients with nodular thyroid disease. Completely asymptomatic nodules require follow-up without treatment. Cosmetic problems or compression related symptoms may be indications for surgery. When surgery is contraindicated or refused, several non-surgical approaches are available. These include levothyroxine therapy, radioiodine treatment, injection of percutaneous ethanol and laser photocoagulation. Levothyroxine therapy is the most widely used approach, but its clinical efficacy and safety are controversial. Treatment with radioiodine is the therapy of choice for toxic nodules or for symptomatic nodular goiters when surgery is not possible. Percutaneous ethanol injection should be used as the first-line therapy for recurrent symptomatic cystic nodules. Laser therapy should be reserved only for selected patients treated in experienced centers. With these options, clinicians can personalize the management of nodular thyroid disease according to a careful cost benefit analysis. (Korean J Endocrine Surg 2007;7:1-8)

방사선 요오드의 국소주입에 의한 양성 갑상선 결절의 치료

하일주,윤정한,제갈영종,범희승<SUP>1<.SUP>,Il-Joo Ha,Jung-Han Yoon,Young-Jong Jaegal,and Hee-Seoung Boom,<SUP>1<.SUP> 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.2

방사선 요오드-131의 국소주입에 의한 양성 갑상선 결절의 치료

제갈영종(Young Jong Jaegal),범희승(Hee Seoung Boom),윤정한(Jung Han Yoon),임동표(Dong Pyo Lim),하일주(Il Joo Ha) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.2

Background and Objective: Percutaneous ethanol injection therapy has been used in the treatment of the benign thyroid diseases. Although the reported side-effects of the therapy was mild and transient, some side-effects including local or radiating pain are troublesome to the patients. Radioactive iodine-131( Ra?131I) also has been effectively and safely used for management of the benign thyroid diseases. So we developed the percutaneous intranodular injection therapy of Ra?131I as an alternative of percutaneous ethanol injection therapy. Materials and Methods: From December 1998 to October 1999, we treated 29 outpatients (25 women and 4 men, mean age: 47±12 years). Inclusion criteria were follows; age >30 years, cytologically benign, with normal thyroid function, cold nodule on thyroid scintigram, solid or mixed natured nodules in sonographical evaluation. Nodular volume was estimated by sonography according to the ellipsoid formula. Ra?131I (0.1mCi/ml) was administered in a single dose injection. Follow-up studies every 3 months consisted of full history, thyroid function test, and sonography. We determined the therapeutic response is effective if the volume reduction of the nodule occurred above 30%. Results: After at least 3 months follow-up, 11 patients showed effective response, 12 patients showed minimal or unchanged response and 6 patients showed progression. Although side-effects such as injection pain, febrile reaction, and hormonal changes were absent, an infectious complication in injection site was developed from 1 case. Conclusion: Although we need a more prolonged follow-up to evaluate the delayed sequelae, we can suggest that percutaneous intranodular injection therapy of Ra?131 I may be an attractive non-surgical treatment in selected cases of benign thyroid nodules.

수술적 치료를 받은 양성 갑상선 결절 환자의 술 후 장기 추적 결과

이호균,윤정한,제갈영종,Ho Kyun Lee,Jung Han Yoon,and Young Jong Jeagal 대한갑상선-내분비외과학회 2003 The Koreran journal of Endocrine Surgery Vol.3 No.2