Inadvertent Parathyroidectomy during Thyroid Surgery for Papillary Thyroid Carcinoma and Postoperative Hypocalcemia

안동빈,손진호,김재혁,박지영,박준식 대한갑상선학회 2012 International Journal of Thyroidology Vol.5 No.1

Background and Objectives: The aim of this article is to report our experience of inadvertent parathyroidectomy during thyroid surgery and to analyze its associated factors and clinical implications. In addition, we attempted to determined causative factors that result in permanent hypocalcemia after thyroid surgery. Materials and Methods: We performed a retrospective review of 500 patients who underwent thyroid surgery for the treatment of papillary thyroid carcinoma from 2004 to 2008. Results: Inadvertent parathyroidectomy was identified in 7.4%of patients and only 1 parathyroid gland was inadvertently removed in most cases. The incidence of inadvertent parathyroidectomy was not associated with gender, age, type of surgical procedure, tumor size,coexisting Hashimoto’s thyroiditis (HT), extra-thyroidal extension (ETE), lymph node (LN) metastasis, and surgeon’s experience. Nor was inadvertent parathyroidectomy associated with permanent postoperative hypocalcemia. Although operating time >120 min, ETE, and total thyroidectomy (TT) with central neck dissection (CND) were found to be related to permanent hypocalcemia on univariate analysis, tumor size ≥1 cm and surgeon’s experience ≤5 years was statistically associated with permanent hypocalcemia on both univariate and multivariate analyses. Conclusion: Although inadvertent parathyroidectomy is not an uncommon complication of thyroid surgery, it appears to have only modest clinical implications. Permanent hypocalcemia was significantly associated with tumor size ≥1 cm and short surgical experience of surgeons, especially in the case of TT with CND. Therefore, we suggest that more accurate risk stratification should be made for routine CND,when it is performed by young surgeons.

Oncocytic Sialolipoma of the Submandibular Gland

안동빈,박태인,박준식,허성재 대한이비인후과학회 2014 Clinical and Experimental Otorhinolaryngology Vol.7 No.2

Sialolipoma, a rare tumor of the salivary gland, is a recently described variant of salivary gland lipoma. Oncocytic sialoli- poma was first described by Pusiol et al. in 2009. We report the case of an oncocytic sialolipoma of the submandibular gland in a 43-year-old female. Excision of the tumor was performed with preservation of the submandibular gland. The tu- mor had a thin, fibrous capsule and consisted of abundant adipose tissue, an oncocytic nodule, and scattered normal glan- dular structures surrounded by adipose tissue. Four cases of sialolipoma of the submandibular gland, including the present case, were reviewed. All 4 tumors were developed on the right submandibular glands, with a composition of adipose tissue as high as that of sialolipoma of the parotid gland; in contrast to previous reports, three cases were in females. As newly described tumor type, care should be taken to distinguish oncocytic sialolipoma from other salivary gland neoplasms such as simple lipoma, pleomorphic adenoma, or oncocytoma.

타석증에 의해 이차적으로 발생한 일측 악하선 결손 1예

안동빈,전범수,손진호,박준식 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.2

Absence of major salivary glands, especially those of occurring unilaterally or secondary to Wharton’s duct stone, is a rare disorder, A case of unilateral submandibular gland absence occurring secondary to Wharton’s duct stone was presented in a 51-year-old male. Using the ultrasonography (USG) and computerized tomography (CT), the absence of the submandibular gland was confirmed. The patient had long-term history of sialolithiasis of the right submandibular gland, so the right submandibular gland was suspected of having acquired a change due to sialolithiasis. The present case would be a second report demonstrating a case of unilateral submandibular gland absence occurring secondary to stones, suggesting that, without ligation of submandibular nerves, the obstruction of excretory duct of a submandibular gland could lead to a complete atrophy of the gland in human.

Preoperative Subclinical Hyperthyroidism in Patients With Papillary Thyroid Carcinoma

안동빈,손진호,전재한,박준식 대한이비인후과학회 2014 Clinical and Experimental Otorhinolaryngology Vol.7 No.4

Objectives. Numerous studies have reported the effects of subclinical hyperthyroidism on the cardiovascular system, os- teoporosis, and metabolic syndrome. However, there are few studies examining the relationships between subclinical hyperthyroidism and thyroid cancer. The aim of this study was to investigate the relationships between preoperative subclinical hyperthyroidism and clinicopathological characteristics in patients with papillary thyroid carcinoma (PTC) in terms of thyroid-stimulating hormone (TSH) levels and TSH receptor antibody (TRAb) values. Methods. Between January 2001 and December 2007, 462 patients were eligible for analysis in our study; we compared the clinicopathological characteristics of 39 preoperative subclinical hyperthyroidism patients with those of 423 eu- thyroid patients. Results. There were no statistical differences between the 2 groups with respect to age, male to female ratio, primary tumor size, extrathyroidal extension (ETE), multifocality, lymph node metastasis, TNM and AMES stages, recurrence, and survival, despite significant difference in TSH concentrations between the 2 groups. In the evaluation for TRAb, pri- mary tumor size was significantly larger in patients with normal TRAb than in patients with elevated TRAb. When the patients were subdivided into 4 categories according to TRAb values (<5.0%; 5.0%–10.0%; 10.1%–15.0%; >15.0%), tumor size and ETE were significantly different. However, we could not find linear relationships in the in- crease or decrease of TRAb values. Conclusion. The results of our study suggest that subclinical hyperthyroidism is not independently associated with tumor aggressiveness and prognosis in PTC in spite of reduced TSH levels and increased TRAb values as compared with eu- thyroid patients.

단일기관에서의 미분화 갑상선암에 대한 경험

안동빈,손진호 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.1

Background and Objectives Although anaplastic thyroid carcinoma (ATC) accounts for less than 2% of all thyroid malignancies, it contributes to 14-50% of deaths related to thyroid tumors. However, there is no definite treatment. The aim of the study is to review our experience of ATC at our own university clinic to look for clues for the management of ATC. Subjects and Method The medical record of 15 patients with ATC treated in our clinic between 1997 and 2010 were retrospectively reviewed. Results Five (33.3%) patients underwent no curative treatment but biopsy or tracheostomy. Complete surgical resection was possible in only one patient. Six patients underwent debulking surgery with or without adjuvant treatment. One and two patients were treated with radiation therapy alone and concurrent chemoradiation therapy (CCRT), respectively. Despite various treatment regimens, there are surviving patients at the time of present evaluation. The mean survival was 253.1 days and median survival was 128 days. Only two patients had survived longer than a year. Each patient had been treated with complete surgical resection and CCRT with doxorubicin, respectively. In univariate analysis, there was no association between survival duration and various clinico-pathological parameters. However, old age (≥65), history of pre-existing thyroid nodule, and radiation therapy was significantly associated with survival duration in multivariate analysis. Conclusion Most ATC was unresponsive to ongoing treatment modalities in our clinic. However, we experienced that a certain treatment was effective in some patients. For the goal of forming a generally effective treatment regimen for ATC, we suggest a prospective multicenter study to be performed on the basis of present study.

일측 경부와 복부에 발생한 Rosai-Dorfman Disease 1예

안동빈,나경진 대한이비인후과학회 부산,울산,경남 지부회 2013 임상이비인후과 Vol.24 No.2

Rosai-Dorfman disease is a rare lymph node disorder characterized by abnormal proliferation of histiocytes and usually presents with bilateral cervical lymphadenopathy. This disease has been poorly understood by otolaryngologists because of its rarity. We report an unusual case of a 61-year-old woman with Rosai-Dorfman disease involving one side of the neck and the abdominal cavity, which distinguishes our case from previous reports. Her symptoms and image findings were consistent with that of a lymphoma. However, histopathological examination of the lymph node revealed emperipolesis, a characteristic feature of Rosai-Dorfman disease. After medical treatment with steroids for 2 weeks, the size of the lymph node decreased by 50%. Since the clinical course of Rosai-Dorfman disease varies from spontaneous remission to fatal outcomes, we believe that Rosai-Dorfman disease should be considered in the differential diagnosis of patients with cervical lymphadenopathy

미세 갑상선 유두암에서 반갑상선절제술 후 발견된 잠복성 다발병변의 임상적 의의

안동빈,손진호,김희진,정지윤,정훈 대한이비인후과학회 2014 대한이비인후과학회지 두경부외과학 Vol.57 No.3

Background and Objectives Occult multifocal diseases are often identified after hemithyroidectomy in patients with papillary thyroid microcarcinoma (PTMC). There has been considerable debate with regard to whether multifocal diseases actually behave more aggressively compared with unifocal diseases, particularly PTMC. The present study aimed at evaluating the clinical impact of occult multifocal diseases on the recurrence of PTMC treated with hemithyroidectomy. Subjects and Method We compared the clinicopathological characteristics and 5-year outcomes for 319 patients with unifocal PTMC patients and 29 patients with occult multifocal PTMC, all of whom were treated with hemithyroidectomy between January 2004 and December 2010. Results The incidence of occult multifocal disease was 8.4%, with a mean size of 0.28 cm. Although microscopic extrathyroidal extension (ETE) was more frequent in patients with occult multifocal PTMC as compared with that of unifocal diseases (41.4% vs. 23.2%, p=0.030), multifocality was not associated with age, primary tumor size, and concurrent Hashimoto’s thyroiditis. With respect to recurrence, there was no difference between the unifocal and multifocal groups during the mean 55.8-month follow-up period (4.4% vs. 10.3%, p=0.160). In addition, univariate and multivariate analyses revealed no meaningful association between recurrence and presence of occult multifocal diseases in patients with PTMC treated with hemithyroidectomy. Conclusion Although presence of occult multifocal diseases was associated with microscopic ETE, its clinical impact on disease recurrence was not significant in PTMC patients treated with hemithyroidectomy. Therefore, multifocality identified after hemithyroidectomy would not be an absolute indication for the completion of thyroidectomy in patients with PTMC. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(3):166-71

갑상선 유두암의 측경부 재발에서 포괄적 경부 림프절절제술과 비교한 제한적 경부 림프절절제술의 치료 성적

안동빈,이선재,박선균,손진호,박준식 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.1

Background and Objectives Therapeutic comprehensive neck dissection has been recommended for the patients with recurrent papillary thyroid carcinoma (PTC) confined to the neck after initial total thyroidectomy. However, the benefit of comprehensive neck dissection to remove asymptomatic metastatic lymph node towards improving clinical recurrences or survival is largely unproven. We analyzed the pattern of recurrence in the lateral compartment of neck and evaluated the possible application of limited lymph node dissection against comprehensive neck dissection. Subjects and Method A retrospective review was carried out for 43 patients who underwent surgical treatment for recurrent PTC in the lateral neck from 2000 to 2005, and their clinicopathological results were stratified according to the extent of surgery into two groups, the limited surgery group and the comprehensive surgery group. Results Recurrence rate in lateral neck after initial total thyroidectomy was 14.5% (43/ 296), and the most common level of recurrence was level IV (50.9%). Although limited surgery group showed a tendency toward more frequent recurrence after treatment of the first recurrence than did the comprehensive surgery group, this tendency had no statistical significance. Moreover, no patients in either group have died of PTC during over a mean follow-up period of 80 months. In the aspect of factors associated with surgical morbidity, such as operating time, duration of admission, and complication, the limited surgery group had superior results when compared to the comprehensive group. Conclusion The benefit of comprehensive neck dissection concerning recurrence and survival was not verified in the present study hence a more preservative approach could be applied to selective patients with recurrent PTC in the lateral compartment of neck.

양성 낭종성 갑상선 결절에서 두경부 외과의에 의해 시행되는 초음파 유도하 에탄올 절제술: 예비보고

안동빈,김희진,이재호,손진호 대한이비인후과학회 2015 대한이비인후과학회지 두경부외과학 Vol.58 No.4

Background and Objectives To evaluate the feasibility of ultrasound-guided ethanol ablation (US-EA) performed by a head and neck surgeon in benign cystic thyroid nodules. Subjects and Method This preliminary study enrolled five patients who underwent US-EA by a single head and neck surgeon for benign cystic thyroid nodules, which had been previously aspirated but recurred. Procedure time, success of targeting, volume reduction rate, satisfaction scores of the procedure, and complications were evaluated. Results The initial mean volume of cystic nodules was 8.3 mL (2.0-18.9). After US-EA, it decreased to 1.2 mL (0.4-3.5 mL) with the mean volume reduction rate of 85.5% (56.2-88.5%). The mean procedure time of surgeon-performed US-EA was 5.6 min (range, 3.7-7.3 min). The procedure was successfully carried out in all patients, with the mean satisfaction score of 7.6 (6-9). There were no major complications but transient burning sensation was reported in one patient. Conclusion US-EA can be performed by head and neck surgeons safely with favorable therapeutic results. This may improve surgeon’s treatment performance of benign cystic thyroid nodules and help achieve streamlined patient care without referring patients to other department.

레이저 성대 절제술을 시행한 조기 성문암 환자의 치료 결과 및 전암성 병변으로 부터의 악성 변환 관찰

안동빈,박지현,허성재,박창묵,정다정,남예모,손진호,박준식 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.7

Background and Objectives Laser cordectomy has been widely acknowledged to have advantages for the treatment of early glottic carcinoma. This study was performed to assess the results of laser cordectomy for its oncologic safeness, time-effectiveness, and to report a few interesting precancerous cases that have progressed to glottic cancer. Subjects and Method Subjects (47) who had undergone laser cordectomy for the treatment of early glottic cancer from April 2006 to July 2009 were enrolled in this study. We analyzed the oncologic outcomes, the duration of hospital treatment after the surgery, and postoperative complications by reviewing of medical records. Results For 47 cases, the mean age was 66 years and the mean follow up period was 22.6months. The mean duration of treatment was 1.9 days. Among them, 24 cases were classified into T1a, 12 T1b, and 2 T2. Local recurrence was observed in 2 cases, so salvage treatments, such as radiation therapy or near total laryngectomy, were performed, and both of them were alive in the disease-free state. The most common complication was anterior commissure web, which was observed in 6 cases (15.8%), followed by granuloma observed in 5 cases (13.1%). Serious complications such as aspiration, respiratory distress, and dysphagia were not found in any of 47 cases. Also, we could observe 3 cases in which the precancerous glottic lesion had progressed to glottic carcinoma over a long period of time. Conclusion Laser cordectomy might be the treatment of choice for patient’s convenience because of its excellent oncologic outcomes, low morbidity, and time-effectiveness. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:425-9