뇌전이를 동반한 갑상선 유두선암 5 예

송영기(Young Kee Shong),박경수(Kyong Soo Park),조보연(Bo Youn Cho),고창순(Chang Soon Koh),오승근(Seung Keun Oh),박성희(Seong Hoe Park),김용일(Yong Il Kim) 대한내과학회 1986 대한내과학회지 Vol.30 No.6

N/A Five cases of differentiated carcinoma of thyroid associated with brain metastasis are reported. All of the patients had distant metastatic diseases or massive invasion of the surrounding tissue at the initial diagnosis. Metastatic lesions in the brain were not detected by conventional radioiodine whole body scan but by computerized axial tomography. TSH suppression, external radiotherapy, and radioactive iodine were tried but no consistently satisfactory effects were achieved. The prognosis of the patients with brain metastasis was poor, four patient diedat two to four months after detection of brain metastasis and only one patient is alive two months after detection, at the time of writing this paper.

Graves 병 환자에서 갑상선 아전절제술 후 갑상선자극항체와 갑상선자극홀몬 결합억제 면역글로불린의 변화

송영기(Young Kee Shong),이병두(Byoung Doo Rhee),조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min),오승근(Seung Keun Oh) 대한내과학회 1989 대한내과학회지 Vol.37 No.1

N/A The authors measured changes in thyroid stimulating antibody (TSAb) and thyrotropin binding inhibitor immunoglobulin (TBII) in 15 patients with Graves' disease treated with subtotal thyroidectomy. Before surgery all 15 had detectable TBII actvities, and 11 had TSAb activities. During the 12 month postoperative follow-up, TBII disappeared in 7 out of 15, and TSAb disappeared in 6 out of 11. Twelve months after surgery, 10 patients with negative TSAb (including 4 patients whose TSAb activities were negative before surgery) remained in remission, Of 5 patients whose TSAb remained persistently positivie during the 12 month observation period, one remained in remission, two experienced relapse, and two became hypothyroid. In the persistently positive TSAb and TBII group, their activities did not change after surgery. There was no difference in clinical and laboratory findings save for the higher TSAb and TBII activity preoperatively between the persistently positive group and disappearing group. In summary, after subtotal thyroidectomy, TSAb and TBII disappeared in some of the patients. Disappearance of TSAb is associated with remission but persistence of TSAb has no prognostic implication. The production sites of thyrotropin reccptor antibody are thought to be intrathyroidal, but in some patients extrathyroidal production might contribute significantly, due to the pattern of postoperative changes in thyrotropin receptor antibody activities.

백서 고환 간질 세포에서 TSH 와 TSH 수용체 항체에 대한 cAMP 와 Testosterone 의 반응

송영기(Young Kee Shong),조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min),이문호(Mun Ho Lee) 대한내과학회 1988 대한내과학회지 Vol.35 No.3

N/A To investigate the physiological role of TSH receptor in testes and the effect of various TSH receptor antibodies (TRAb), we measured cAMP production ad testosterone release in enzymatically dispersed rat testicular interstitial cells under the stimulation of TSH and TRAb, and compared the results with in those of tests done in FRTL-5 cells. TSH increased cAMP production and testosterone release in a dose-dependent manner similar to hCG. TSAb which stimulated thyroid adenylate cyclase (AC) were able to stimulate teaticular interstitial cell AC in 8 out of 30 patients (277p) and testosterone release in 12 out of 30(40%) patients with Graves' disease. Blocking type TRAb inhibited TSH-induced cAMP production and testosterone release in a dose-dependent manner but had no effect on basal cAMP production and testosterne release, These findings suggest that TSH receptors in testes might have a somewhat dissimilar nature from that in the thyroid and that testicular TSH receptor might be involved in testosterone production.

Graves 병에서 배양된 백서 갑상선 세포 ( FRTL - 5 ) 를 이용한 갑상선 자극항체의 측정 - 기본적 검토 및 임상적 의의 -

조보연(Bo Youn Cho),송영기(Young Kee Shong),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min),이문호(Mun Ho Lee) 대한내과학회 1988 대한내과학회지 Vol.34 No.2

N/A We tried to assess the best conditions to measure thyroid stimulating antibodies (TSAb) using cultured rat thyroid cell ling (FRTL-5), And also to evaluate the frequencies of TSAb in Graves' disease, changes of TSAb activities during antithyroid drug treatment, and whether the presence of TSAb at the end of treatment can predict the relapse, we measured TSAb using FRTL-5 cells in 40 normal controls and 179 patients with autoimmune thyroid diseases. The results are as following; 1) The cAMP responses of FRTL-5 cells to TSH and TSAb began to increase from 3 days after TSH withrawal from culture media and reached peak response at the 7th day, and thereafter decreased. 2) The cAMP responses of FRTL-5 cells to TSH and TSAb increased in relation to incubation times. 3) The dose-response curves of TSH and TSAb, stimulating cAMP production in FRTL-5 cells, showed similary sigmoid curves. The minimum levels of TSH and TSAb which showed significant increase of cAMP were 2-5 μU/ml and 0.15-0.3mg/well, respectively. 4) Intracelluar cAMP levels were correlated closely with extracelluar cAMP levels. About 75-80% of total cAMP levels was released into culture supernatant. 5) The frequencies of detectable TSAb in 57 patients with untreated Graves' disease, in 55 patients with euthyroidism under treatment and in 18 patients with remission were 93%, 56.4% and 11.1%, respectively. However, only 2 out of 21 patients with Hashimoto's thyroditis had low titers of TSAb in their sera. TSAb were not present in sera of all 28 patients with primary nongoitrous myxedema. 6) TSAb activites were singnificantly correlated with TBII activities (r=0.635, p<0.001). 7) In remission group, TSAb activities decresed significantly from 3 months after treatment, and disappeared in alomost all cases within 12 months. However, those activities were not changed significantly untill the end of treatment in relapse group. 8) The positive rate of TSAb in 27 patients who were in remission after treatment was 38.7%, however, that in 28 patients who relapse within 12 months aftr discontinuation of drugs was 77.8%. The predicitve value of TSAb for relapse was 67.7%, which was similar with that of TBII (71.4%). These findings suggest that determination of TSAb using FRTL-5 cells is very sensitive and specific method and that TSAb is one of major cause of hyperthyroidism in Graves disease, and its determination can be useful for the evaluation of clinical course and prognosis in patients with Graves disease.

배양된 쥐 갑상선세포 성장에 미치는 각종 성장인자들과 TSH 수용체항체간의 상호작용 및 그 기전에 관한 연구

조보연(Bo Youn Cho),송영기(Young Kee Shong),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min) 대한내과학회 1989 대한내과학회지 Vol.37 No.3

N/A To evaluate the interaction of various growth factors and TSH receptor antibodies (TRAb) on the growth of cultured rat thyroid cells, FRTL-5 cells, and to verify their mechanisms of action, we measured 3H-thymidine incorporation into FRTL-5 cells with various combinations of TSH, Graves' IgG and other growth stimulators (insulin, IGF-I, multiplication stimulation activity, forskolin, dBcAMP and phorbol ester). We evaluated the effects of blocking TRAb and adenosine on the growth factor-stimulated growth of FRTL-5 cells. Insulin, IGF-I and MSA increased 3H-thymidine incorporation into FRTL-5 cells and showed a synergistic effect when incubated simultaneously with TSH or Graves IgG. Forskolin, PGE2, and dBcAMP also increased 3H-thymidine incorporation by themselves and their effects were synergistically potentiated by insulin and IGF-I. Adenosine inhibited both TSH and Graves' IgG induced 3H-thymidine incorporation into FRTL-5 cells. Blocking TRAb inhibited both TSH and Graves' IgG induced 3H-thymidine incorporation, but did not inhibit the effects of insulin, IGF-I, forskolin and dBcAMP on the growth of FRTL-5 cells. Phorbol ester (TPA) did stimulate the growth of FRTL-5 cells by itself and inhibited both TSH and Graves IgG induced 3H-thymidine incorporation into FRTL-5 cells. These results suggest that 1) there might be two or more signal transduction systems for the growth of thyroid cells; TSH and Graves IgG stimulate the growth of thyroid cells through the adenylate cyclase-cAMP system, and IGF-I and other growth facors act through another system, and 2) blocking TRAb may inhibit the growth of thyroid cells by inhibiting TSH-stimulated cAMP generation.

일차성 점액수종에서 차단형 TSH 수용체 항체의 병인론적 역할 - 빈도 , 특성 및 임상상과의 관계 -

고창순(Chang Soon Koh),송영기(Young Kee Shong),조보연(Bo Youn Cho) 대한내과학회 1988 대한내과학회지 Vol.35 No.3

N/A To evaluate the pathogenetic role of blocking type TSH receptor antibodies in primary nongoitrous myxedema, we measured TSH-binding inhibitor immunoglobulin (TBII) using radioreceptor assay, studied the characteristics of this IgG, and analyzed the clinical and laboratory features in 2S patients with primary myxedema. TBI1 was detected in 15 (54.6%) out of 28 patients with primary myxedema. Among them, 13 patients showed potent TBII activities of more than 70% inhibition of 125I-bTSH binding in the assay. How-ever, only 5 (18.5%) out of 27 patients with goitrous hypothyroidism had TBII activities of low titers. IgGs from patients with primary myxedema inhibited the receptor binding of 125I-bTSH dose-dependently. They also inhibited the cAMP increases in FRTL-5 cells induced by TSH, as well as those induced by Graves 1gG, in a dose-dependent manner, We treated a patient with primary myxedema who had potent TBII activity with high dose of prednisolone for 2 months. Although TBII activities decreased gradually (Tl/2=3.7 weeks), the thyroid function did not improve. Transient neonatal hypothyroidism was found in an infant born to a mother having potent TBII activities. Serum of the infant also had potent TBII activities and the infants IgG inhibited cAMP increases induced by TSH. Gradual disappearance of this IgG was followed by the resolution of hypothyroidism. These findings suggest that a significant proportion of patients with primary myxedema have potent blocking type TSH receptor antibodies which may play a role in primary myxedema causing hypothyoidism through inhibiting TSH-stimulated cAMP generation,

정상인 및 갑상선질환 환자에서 Thyroxine 투여에 따른 TSH 분비능 억제에 관한 연구

고창순 ( Chang Soon Koh ),조보연 ( Bo Youn Cho ),문대혁 ( Dae Hyuk Moon ),이동수 ( Dong Soo Lee ),김상은 ( Sang Eun Kim ),송영기 ( Young Ki Song ) 대한내과학회 1985 대한내과학회지 Vol.29 No.2

항 - IgG 항체에 의한 차단형 TSH 수용체 항체의 자극형 항체로의 전환

송민호(Min Ho Shong),이가희(Ka Hee Yi),조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min),송영기(Young Kee Shong) 대한내과학회 1991 대한내과학회지 Vol.41 No.5

N/A We examined the conversion phenomenon of thyrotropin rceptor-bound blocking type immunog-lobulin G to the stimulating type by antihuman IgG antibody for the evaluation of the mechanism involved in the conversion, in vitro. Blocking-type IgG was purified from a patient with primary myxedema. In the conversion experiment. FRTL-5 cells were first incubated with blocking-type lgG solution at 37°C for 30 min, then washed with Hanks Balanced Salt Solution and, secondly, incubated with the solution containing antihuman IgG antibody at 4°C for 1.5 h and then for 3 h at 37°C. The antihuman IgG antibody to the cell-bound blocking type IgG resulted in an increase of Camp production in a dose dependent manner. Of the several types of antihuman IgG antibodies tested, antibodies against F fragment and divalent Fab frament showed the most effective conversion, while the least effective were those against the F, fragment. IgG from patients with high titer of rheumatoid factor did not convert cell-bound blocking type IgG to the stimulating type. Antihuman IgG antibody did not interfere with the TBII activity of the blocking type IgG antibody did not interfere with the TBII activity of the blocking type IgG. Simultaneous addition of antihuman IgG antibody and TSH (0.1 Mu/ml) increased Camp production to a greater degree than the individual addition of either. These results suggest that blocking-type TSH receptor antibody and stimulating-type antibody bind to the similar epitope of TSH eceptor, and that IgG against TSH receptor antibodyr may also play a patho-physiological role in vivo.

일차성 점액수종환자에서 차단형 TSH 수용체항체의 유무에 따른 임상상의 차이

이가희(Ka Hee Yi),안종호(Chong Ho Ahn),김원배(Won Bae Kim),정재훈(Jae Hoon Chung),조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),송영기(Young Kee Shong) 대한내과학회 1994 대한내과학회지 Vol.47 No.5

N/A Objectives: To elucidate primary myxedema characterized by progressive atrophy of the thyroid gland and primary hypothyroidism is caused by the blocking type TSH receptor antibody and as a end result of Hashimoto's thyroiditis as well. Methods: We measured thyrotropin-binding inhibitory immunoglobulin (TBII) using radioreceptor assay and thyroid-stimuiation blocking antibody (TSBAb) by bioassay using rat thyroid cell line, FRTL-5, in the sera from 84 patients with primary myxedema and from 61 patients with Hashimoto's thyroiditis and compared their clinical characteristics. Results: Among the patients with primary myxedema THII was detected in 39 patients (46%) and TSBAb in 47 patients (64%). In patients with Hashimoto's thyroiditis, TBII was detected only in 3 patients (5%) and TSBAb in 3 patients (8.8%). The prevalences of both TBII and TSBAb were significantly higher in primary myxedema than those in Hashimoto's thyroiditis. TSBAb activity was significantly higher in TRII positive primary myxedema patients when compared with TBII negative and was positively correlated with TBII activity. The activities of both TBII and TSBAb measured in patients with Hashimoto's thyroiditis were much lower than those in primary myxedema. The mean age at the onset of primary myxedema was significantly lower in the patients with TBII. When compared with the patients with Hashimoto's thyroiditis, mean age at the onset of disease was significantly older in the TBII negative primary myxedema patients. But the age of disease onset in TBII positive myxedema was not different from that of Hashimoto's patients. As the patients were younger at the onset of disease, the prevalence of TBII was higher: for the patients under the age of 29, TBII was detected in 76%, for between 30 and 39, 55%, for 40~49, 45%, for 50~59, 16 % and for over 60, 38 %, respectively (ψ²=24.77, df=l, p<0.05). Among the patients with primary myxedema, 24h 1311-thyroid uptake values were significantly lower in patients with TBII compared to those without TBII (1.5±1.1% vs. 4.1±3.9% p<0.05). Conclusion: These results suggest that primary myxedema may be a heterogenous disease: for the development of hypothyroidism, blocking type TSH receptor antibodies play a major role in one group, especially young patients and cell-mediated destructive mechanisms may be important in another group.

경골전 점액수종을 보인 Graves병

이애영(Ai Young Lee),김기호(Ki Ho Kim),김정애(Jeong Aee Kim),이유신(Yoo Shin Lee),송영기(Young Kee Shong),조보연(Bo Youn Cho) 대한피부과학회 1989 대한피부과학회지 Vol.27 No.5

A case of pretibisl myxederna in typical Graves disease was described. A 50-year-old woman revealed diffuse toxic goiter, exophthalmos, and pretibial myxedema. From light and electron microscopic findings, large amount of acid mucopolysaccharides were deposited in the stroma and fibroblssts. In spite of elevation of TBII (a kind of thyroid stimulatory factors, negative direct immunofluorescence of lesional skin and no response. of pretibial myxedema to the treatment with antithyroid drug (propylthiouracil) suggested stimulstory factors of fibroblasts might be different from those of thyroid gland.