Gender-Dependent Reference Range of Serum Calcitonin Levels in Healthy Korean Adults

송의연,전민지,류혜진,배성진,김태용,김원배,송영기,김홍규,김원구 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.2

Background: Serum calcitonin measurement contains various clinical and methodological aspects. Its reference level is wide andunclear despite sensitive calcitonin kits are available. This study aimed to identify the specific reference range in the healthy Koreanadults. Methods: Subjects were ≥20 years with available calcitonin (measured by a two-site immunoradiometric assay) data by a routinehealth checkup. Three groups were defined as all eligible subjects (group 1, n=10,566); subjects without self or family history ofthyroid disease (group 2, n=5,152); and subjects without chronic kidney disease, autoimmune thyroid disease, medication of protonpump inhibitor/H2 blocker/steroid, or other malignancies (group 3, n=4,638). Results: This study included 6,341 male and 4,225 female subjects. Males had higher mean calcitonin than females (2.3 pg/mL vs. 1.9 pg/mL, P<0.001) in group 1. This gender difference remained similar in groups 2 and 3. Calcitonin according to age or bodymass index was not significant in both genders. Higher calcitonin in smoking than nonsmoking men was observed but not in women. Sixty-nine subjects had calcitonin higher than the upper reference limit (10 pg/mL) and 64 of them had factors associated with hypercalcitoninemia besides medullary thyroid cancer. Our study suggests the reference intervals for men who were non, ex-, currentsmokers, and women (irrespective of smoking status) as <5.7, <7.1, <7.9, and <3.6 pg/mL, respectively. Conclusion: Specific calcitonin reference range should be provided considering for sex and smoking status. Taking account for several factors known to induce hypercalcitoninemia can help interpret the gray zone of moderately elevated calcitonin.

연안여객선 종사자의 BRM/ERM 교육시스템도입과 해난사고 감소의 인과적 관계에 관한 연구

송의연,김명재 해양환경안전학회 2017 해양환경안전학회 학술발표대회 논문집 Vol.2017 No.11

렌바티닙 사용과 관련된 고혈압과 단백뇨의 관리: 증례 보고

송의연,김원구 대한갑상선학회 2018 International Journal of Thyroidology Vol.11 No.2

Lenvatinib, an oral multi-kinase inhibitor, is a valuable treatment option for advanced differentiated thyroid carcinoma. However, severe treatment-related adverse events occur up to 30% of the patients receiving lenvatinib, making it a challenge for clinicians to maintain this drug and therefore affecting the outcome of therapy. Blood vessel related events, such as hypertension or proteinuria, are among the most frequent adverse events. We present a case of 65-year-old man with radioactive iodine refractory papillary thyroid carcinoma with cervical lymph node metastasis and tracheal invasion receiving lenvatinib who developed proteinuria and worsening of hypertension. Management with repeated dose reductions and using supportive medications allowed this patient to continue lenvatinib with his disease stably controlled. Early detection of patients at risk for these adverse events and cautious administration of lenvatinib at appropriate level are crucial in managing patients receiving lenvatinib.

Risk of Diabetes in Patients with Long-Standing Graves’ Disease: A Longitudinal Study

송의연,Min Ji Koo,Eunjin Noh,황순영,Min Jeong Park,김정아,Eun Roh,Kyung Mook Choi,Sei Hyun Baik,Geum Joon Cho,류혜진 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.6

Background: The detrimental effects of excessive thyroid hormone on glucose metabolism have been widely investigated. However, the risk of diabetes in patients with long-standing hyperthyroidism, especially according to treatment modality, remains uncertain, with few longitudinal studies. Methods: The risk of diabetes in patients with Graves’ disease treated with antithyroid drugs (ATDs) for longer than the conventional duration (≥2 years) was compared with that in age-and sex-matched controls. The risk was further compared according to subsequent treatment modalities after a 24-month course of ATD: continuation of ATD (ATD group) vs. radioactive iodine ablation (RIA) group. Results: A total of 4,593 patients were included. Diabetes was diagnosed in 751 (16.3%) patients over a follow-up of 7.3 years. The hazard ratio (HR) for diabetes, after adjusting for various known risk factors, was 1.18 (95% confidence interval [CI], 1.10 to 1.28) in patients with hyperthyroidism. Among the treatment modality groups, the RIA group (n=102) had a higher risk of diabetes than the ATD group (n=4,491) with HR of 1.56 (95% CI, 1.01 to 2.42). Further, the risk of diabetes increased with an increase in the ATD treatment duration (P for trend=0.019). Conclusion: The risk of diabetes was significantly higher in patients with long-standing Graves’ disease than in the general population, especially in patients who underwent RIA and prolonged ATD treatment. Special attention to hyperglycemia during follow-up along with effective control of hyperthyroidism may be necessary to reduce the risk of diabetes in these patients.

세월호사고로 살펴본 연안여객항로의 안전정책

김명재,송의연 해양환경안전학회 2014 해양환경안전학회 학술발표대회 논문집 Vol.2014 No.06

지난 4월16일 발생된 세월호의 사고는 300명 이상의 인명피해가 발생되는 대형 참사로 기록되고 있다. 이로 인하여 국내외적인 국객이 현저히 추락하고 해상에서의 안전에 관한 후진적 이미지가 강하게 각인되었다. 그간 우리나라는 고도 성장기를 거쳐 경제적 성장은 이루었으나 국민생활의 안전지수는 후진성을 면치 못하고 있음을 반영하고 있다. 본고에서는 이러한 점을 인식하여 연안여객항로의 현황과 운영 실태를 분석하고, 안전한 해상여객운송을 위한 개선.. The ship casualty of "Sewol" with the death more than 300 persons has been recorded as one of the most biggest accidents in the coastal passenger shipping recently whereby the nation"s credit has been also remarkably dropped against overseas especially..

Case : A patient with extensive bone metastasis as a first sign of medullary thyroid carcinoma

이혜승,송의연,김정아,노은,류혜진,최경묵,백세현 대한내과학회 2020 대한내과학회 추계학술대회 Vol.2020 No.1

분화갑상선암에 대한 방사성요오드 잔여갑상선 제거 후 전신스캔에서 우연히 발견된 난소의 성숙기형종과 요관암

오혜선,송의연,송동은,김원배 대한갑상선학회 2016 International Journal of Thyroidology Vol.9 No.2

Post-therapeutic whole body scan (RxWBS) after radioactive iodine (RAI) remnant ablation (RRA) is useful for detect recurrent or metastatic foci of differentiated thyroid carcinoma (DTC) after total thyroidectomy. However, there is rare possibility of false positive iodine uptake in WBS. Here, we report a case of a 72-year-old woman, who underwent RRA after total thyroidectomy due to follicular variant papillary thyroid carcinoma. There is an abnormal iodine uptake in RxWBS in pelvic cavity. Additional single photon emission computed tomography (SPECT)-computed tomography (CT) imaging showed an intensive I-131 avid mass in left ovary. There was a multiple calcified mass in left ovary and enhancing wall thickening in left ureter with hydronephrosis in contrast enhanced CT. She underwent hysterectomy, oophorectomy, left ureterectomy and nephrectomy and diagnosed as mature cystic teratoma with thyroid tissues and ureter cancer. Struma ovarii should be considered if there was abnormal RAI uptake in pelvic cavity. I-131 SPECT-CT is useful for differential diagnosis of abnormal iodine uptakes in WBS.

Quality of Life in Patients with Papillary Thyroid Microcarcinoma According to Treatment: Total Thyroidectomy with or without Radioactive Iodine Ablation

안종화,전민지,송의연,김태용,김원배,송영기,김원구 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.1

Background: Recently, there has been some controversy regarding the role of radioactive iodine (RAI) ablation in the treatment oflow-risk differentiated thyroid carcinoma (DTC), especially papillary thyroid microcarcinoma (PTMC). This study aimed to compare quality of life (QoL) parameters between patients with PTMC who underwent total thyroidectomy (TT) alone and those whounderwent TT with RAI ablation. Methods: In this cross-sectional study, patients with PTMC who underwent TT with/without RAI remnant ablation were prospectively enrolled between June 2016 and October 2017. All patients completed three questionnaires: the 12-item short-form health survey (SF-12), thyroid cancer-specific quality of life (THYCA-QoL) questionnaire, and fear of progression (FoP) questionnaire. Results: The TT and TT with RAI groups comprised 107 and 182 patients, respectively. The TT with RAI group had significantlylower serum thyrotropin (TSH) levels than the TT group. However, after matching for TSH levels between the groups (n=100 in bothgroups), there were no significant differences in baseline characteristics. According to the SF-12, the score for general health was significantly lower in the TT with RAI group than in the TT group (P=0.047). The THYCA-QoL also showed a significant difference inthe “felt chilly” score between groups (P=0.023). No significant differences in FoP scores were observed between the groups. Conclusion: Patients with PTMC who underwent TT with RAI ablation experienced more health-related problems than those managed with TT alone. These findings support the idea that RAI ablation should be carefully considered in patients with low-risk DTCs.

Clinical Outcomes after Early and Delayed Radioiodine Remnant Ablation in Patients with Low-Risk Papillary Thyroid Carcinoma: Propensity Score Matching Analysis

안종화,김미화,송의연,전민지,김태용,류진숙,김원배,송영기,한지민,김원구 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.4

Background: The clinical outcomes of delayed radioiodine remnant ablation (RRA) therapy in patients with low-risk papillary thyroid carcinoma (PTC) are unclear. We aimed to evaluate the clinical impact of the interval between total thyroidectomy (TT) and RRA therapy in patients with low-risk PTC. Methods: We included 526 patients who underwent TT and RRA for low-risk PTC with a primary tumor size of >1 cm between2000 and 2012. Patients were divided into the early (<90 days) and the delayed (≥90 days) RRA groups based on the interval between TT and RRA. The results of diagnostic whole-body scan (DxWBS), ongoing risk stratification (ORS; response to therapy), and disease-free survival (DFS) were evaluated before and after propensity score matching (PSM). Results: Among the 526 patients, 75 (14.3%) patients underwent delayed RRA; they had more cervical lymph node metastasis and received a higher RRA dose than those who underwent early RRA. The median follow-up period was 9.1 years after initial therapy, and the structural recurrence rate was 1.9%. In DxWBS, 60 patients had focal iodine uptake limited in operative bed, with no significant difference between groups. According to ORS, 78%, 20%, 1%, and 1% patients were classified into excellent, indeterminate, biochemical incomplete, and structural incomplete response groups, respectively. There was no significant difference in ORS or DFS between groups before and after PSM. Conclusion: The timing of the first RRA had no clinical impact in patients with low-risk PTC. Thus, the clinical decision for RRA can be determined >3 months after TT considering other prognostic factors.

AM1638, a GPR40-Full Agonist, Inhibited PalmitateInduced ROS Production and Endoplasmic Reticulum Stress, Enhancing HUVEC Viability in an NRF2-Dependent Manner

류혜진,황환진,김주원,윤석환,박민정,송의연,장수연,장아름,최경묵,백세현 대한내분비학회 2023 Endocrinology and metabolism Vol.38 No.6

Background: G protein-coupled receptor 40 (GPR40) is a key molecule in diabetes and fatty liver, but its role in endothelial dysfunction remains unclear. Our objective in this study was to determine whether GPR40 agonists protect endothelial cells against palmitatemediated oxidative stress. Methods: Human umbilical vein endothelial cells (HUVECs) were used to investigate effects of various GPR40 agonists on vascular endothelium. Results: In HUVECs, AM1638, a GPR40-full agonist, enhanced nuclear factor erythroid 2–related factor 2 (NRF2) translocation to the nucleus and heme oxygenase-1 (HO-1) expression, which blocked palmitate-induced superoxide production. Those antioxidant effects were not detected after treatment with LY2922470 or TAK875, GPR40-partial agonists, suggesting that GPR40 regulates reactive oxygen species (ROS) removal in a ligand-dependent manner. We also found that palmitate-induced CCAAT/enhancer‐binding protein homologous protein expression; X-box binding protein-1 splicing, nuclear condensation, and fragmentation; and caspase-3 cleavage were all blocked in an NRF2-dependent manner after AM1638 treatment. Both LY2922470 and TAK875 also improved cell viability independent of the NRF2/ROS pathway by reducing palmitate-mediated endoplasmic reticulum stress and nuclear damage. GPR40 agonists thus have beneficial effects against palmitate in HUVECs. In particular, AM1638 reduced palmitate-induced superoxide production and cytotoxicity in an NRF2/HO-1 dependent manner. Conclusion: GPR40 could be developed as a good therapeutic target to prevent or treat cardiovascular diseases such as atherosclerosis.