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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)
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.
갑상선암의 내시경 갑상선 절제술에서 근전절제술 및 전절제술의 임상적 비교
유한모,김태원,배자성<SUP>1<,SUP>,조항주,김기환,안창혁,박우찬<SUP>2<,SUP>,이동호<SUP>3<,SUP>,김정수,Han Mo Yoo,M,D,Tae Won Kim,M,D,Ja Sung Bae,M,D,<SUP>1<,SUP>,Hang Joo Cho,M,D,Kee Hwan Kim,M,D,Chang Hyuk An,M,D,Woo Chan Park,M 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.4
Purpose: The aim of this study was to evaluate and compare the surgical outcomes of endoscopic total and near-total thyroidectomies in patients with thyroid cancer. Methods: Between February 2000 and January 2009, among 387 patients who underwent endoscopic thyroidectomy in our hospital, we evaluated 50 patients who underwent endoscopic total or near-total thyroidectomy. Thirty- five and 15 patients underwent endoscopic total thyroidectomy and near-total thyroidectomy, respectively. We analyzed the patients' clinicopathologic characteristics and post-operative complications between the two groups. Results: The mean size of tumors was 1.08 cm (range, 0.1∼3.5 cm) and the mean operative time was 192 minutes. Forty-nine tumors were papillary cancers and 1 tumor was a follicular cancer. Two patients in the endoscopic total thyroidectomy group underwent re-operation because of bleeding. In the near-total thyroidectomy group, one patient had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. In the total thyroidectomy group, nine patients had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. There was no statistical difference in the post-operative complicationrates between the two groups (P=0.254 for hypocalcemia and P=0.470 for injury to the recurrent laryngeal nerve). Conclusion: Based on our experience, endoscopic total thyroidectomy is a safe and feasible alternative to endoscopic near-total thyroidectomy. (Korean J Endocrine Surg 2009; 9:201-205)
갑상샘의 미만성 경화아형 유두상암의 1예 보고: 초음파와 컴퓨터 단층촬영 영상
김흥철,남궁숙,홍명선,황임경,김한준<SUP>1<.SUP>,최영희<SUP>2<.SUP>,Heung Cheol Kim,M.D.,Sook Namkung,M.D.,Myong Son Hong,M.D.,Im Kyung Hwang,M.D.,Han Joon Kim,M.D.<SUP>1<.SUP> and Young Hee Choi,M.D.<SUP>2<.SUP> 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.1
We report here on a case of diffuse sclerosing papillary carcinoma (DSPC), which is a subtype of papillary carcinoma of thyroid, in a 27-year-old female. The ultrasound images showed diffuse enlargement of the thyroid lobes and this was associated with underlying diffuse scattered microcalcifications and a heterogeneous hypoechoic background parenchyma that was without any masses. The CT image showeddiffuse scattered dot-like hyperdensities with bilateral multiple metastastic lymph nodes. Because making the cytological diagnosis of DSPC is still challenging, the radiological findings that show this disease's characteristic features may be important clues for making the correct diagnosis. <B>(Ko</B><B></B><B>rean J Endocrine Surg 2008;8:43-47)</B>
고위험군 유두상 갑상선암 환자에 대한 방사성옥소 최대허용선량 측정법 및 치료법의 검증
김정철,윤정한,제갈영종,범희승<SUP>1<.SUP>,Jung Chul Kim,M.D.,Jung Han Yoon,M.D.,Young Jong Jaegal,M.D. and Hee Seung Bum,M.D.<SUP>1<.SUP> 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2
Purpose: Radioiodine (I-131) therapy is an effective modality to reduce both recurrence and mortality rates in differentiated thyroid cancer. Whether higher doses shows higher therapeutic responses was still debatable. The purpose of this study was to validate curve-fitting (CF) method measuring maximum permissible dose (MPD) by a biological dosimetry using metaphase analysis of peripheral blood lymphocytes. Methods: Therapeutic effects of MPD was also evaluated in 58 patients (49 females and 9 males, mean age 50⁑11 years) of papillary thyroid cancer. Among them 43 patients were treated with ≤7.4 GBq, while 15 patients with ≥9.25 GBq. The former was defined as low-dose group, and the latter high-dose group. Therapeutic response was defined as complete response when complete disappearance of lesions on follow-up I-131 scan and undetectable serum thyroglobulin levels were found. Statistical comparison between groups were done using chi-square test. P value less than 0.05 was regarded as statistically significant. Results: MPD measured by CF method using tracer and therapeutic doses were 13.3⁑1.9 and 13.8⁑2.1 GBq, respectively (P=0.20). They showed a significant correlation (r=0.8, P<0.0001). Exposed doses to blood measured by CF and biological methods were 1.54⁑0.03 and 1.78⁑0.03 Gy (P=0.01). They also showed a significant correlation (r=0.86, P=0.01). High-dose group showed a significantly higher rate of complete response (12/15, 80%) as compared to the low-dose group (22/43, 51.2%) (P=0.05). While occurrence of side effects was not different between two groups (40% vs. 30.2%, P=0.46). Conclusions: measurement of MPD using CF method is reliable, and the high-dose I-131 therapy using MPD gains significantly higher therapeutic effects as compared with low-dose therapy. (Korean J Endocrine Surg 2002;2:97-104)
정파종,김성우,박찬현<SUP>1<.SUP>,김한준,Pa Jong Jung,M.D.,Sung Woo Kim,M.D.,Chan Hyun Park,M.D.<SUP>1 <.SUP>and Han Joon Kim,M.D. 대한갑상선-내분비외과학회 2003 The Koreran journal of Endocrine Surgery Vol.3 No.1
The enlarged parathyroid glands associated with chronic renal failure were recognized during the 1930's. The number of patients on long-term hemodialysis due to chronic renal failure is steadily increasing and the hyperparathyroid state certainly became a clinical problem in the dialysis population. The physiologic mechanisms leading to secondary hyperparathyroidism are multifactorial with renal phosphate retention, skeletal resistance to parathyroid hormone (PTH) action and impairment vitamin D metabolism being some of the known factors. Despite intensive medical management however inadequate control of parathyroid hyperplasia may necessitate surgical intervention. The goal of surgical therapy is to resect sufficient tissue to reverse the hyperparathyroidism without rendering the patient permanently hypoparathyroidism. We experienced a case of secondary hyperparathyroidism and reported its result of total parathyroidectomy, autogenous transplantation and cryopreservation of parathyroid gland. (Korean J Endocrine Surg 2002;2:57-62)
서수한<SUP>1<.SUP>,이정훈<SUP>2<.SUP>,소의영<SUP>2<.SUP>,Su Han Seo<SUP>1<.SUP>,Jung Hun Lee<SUP>2<.SUP> and Euy Young Soh<SUP>2<.SUP> 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.1
Most patients with thyroid cancer (of follicular cell origin) are successfully managed with a combination of surgery, radioactive iodine (<SUP>131</SUP>I-RAI), and suppression of thyroid-stimulating hormone with thyroid hormone replacement, obtaining survival rates approaching 90% at 20 years. Although the prognosis of patients with differentiated thyroid carcinoma (DTC) is favorable, recurrence occurs in up to 30% patients. In addition, many patients with recurrent or metastatic disease, as well as those with less differentiated tumors, will have a much poorer prognosis and lose their ability to concentrate functional iodine and are therefore not targeted by <SUP>131</SUP>I-RAI therapy. There are many treatment options but no definitive treatment for radioiodine refractory thyroid cancer. This paper will discuss the roles of surgical treatment for patients with radioiodine refractory thyroid cancer.