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.

갑상선질환 및 비갑상선질환에서 TSH 측정의 진단적 의의

이가희(Ka Hee Yi),조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min) 대한내과학회 1991 대한내과학회지 Vol.40 No.3

N/A The diagnostic value of basal serum TSH measured by ultrasensitive IRMA was evaluated. For hyperthyroidism, we measured serum TSH by IRMA in 499 patients with thyroid diseases and analysed the causes of undetectable TSH levels in 821 serum samples referred for thyroid function test during one month (May, 1988). For euthyroid sick syndrome in nonthyroidal ill- nesses, we measured serum TSH using IRMA in 411 patients hospitalized due to nonthyroida1 illnesses and in 105 randomly selected patients, T3, T3RU, T4, FT4I, FT4 and rT3 were also measured by RIA. The mean of serum TSH level in 178 normal controls was 1.39±0.76 μU/ml(log mean=1.18)and the 99% confidence range(mean±3SD) was 0.19~7.4 μU/ml. the serum TSH levels of 141 patients with Graves disease were below 0.19 μU/ml and those of 136 patients (96.4%) were undetectable. In patients with thyroid diseases other than Graves disease, the serum TSH levels were decreased below 0.19 uU/ml in 6. The diagnostic sensitivity of TSH by IRMA for hyperthyroidism was 100% (141/141), and specificity was 97.8%(271/277). 176 samples (21.4%) out of 821 sera referred for thyroid function test for one month showed undetectable TSH levels. The undetectable TSH lebels were caused by Graves' hyperthyroidism in 127(72%), Graves' disease under treatment (euthyroidism) in 38(22%), thyoxine treatment in 7(3.4%), subacute thyroiditis in 2(1%), and thyroid nodule in 2(1%). Among 411 patients hospitalized due to nonthyroidal illnesses (NTI), 16 patients (3.9%) showed undetectable or low (<0.19μU/ml) TSH levels and 4 patients (0.9%) showed raised (>7.4 μU/ml) TSH levels. 6(3%) of 20 patients with abnormal TSH levels had received steroid therapy which suppress TSH secretion and 1(5%) had received metoclopropamide which antagonize dopaminergic inhibition of TSH secretion. Only 13(3.2%) out of 411 patients showed abnormal TSH levels due to NTI. Results of thyroid function test in randomly selected 105 patients with NTI showed low total T3 levels in 79(75.2%), low total T4 in 31(29.5%), low FT4I in in 11(10.5%), raised FT4 in 17(16.2%), decreased FT4 in 5(4.8%), raised rT3 in 38(36.2%), decreased rT3 in 13(12.4%). In contrast, TSH levels were abnormal only in 6(5.7%), increased in 2(1.9%) and decreased in 4(3.8%) patients with NTI. Therefore basal seum TSH measured by IRMA can represent status of pituitary-thyroid axis both in patients with thyroid diseases, especially hyperthyroidism and nonthyroidal illnesses.

대한갑상선학회 갑상선결절 및 암 진료 권고안 개정안

이가희 ( Ka Hee Yi ),박영주 ( Young Joo Park ),궁성수 ( Sung-soo Koong ),김정한 ( Jung-han Kim ),나동규 ( Dong Gyu Na ),류진숙 ( Jin-sook Ryu ),박소연 ( So Yeon Park ),박인애 ( In Ae Park ),백정환 ( Chung-hwan Baek ),송영기 ( Youn 대한갑상선학회 2010 International Journal of Thyroidology Vol.3 No.2

의학강좌 : 개원의를 위한 모범처방 ; 갑상선 결절의 최신 진료 지침: 대한갑상선학회 갑상선 결절 및 암 진료 권고안 개정안을 중심으로

이가희 ( Hee Yi Ka ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2

장기간의 갑상선 호르몬 치료가 골밀도에 미치는 영향

이가희(Ka Hee Yi),조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min) 대한내과학회 1991 대한내과학회지 Vol.40 No.3

N/A Both spontaneous and exogenous hyperthyroidism result in osteoporosis by increased bone-remodeling. We studied the effect of long-term suppressive thyroxine therapy on axial bone density in 59 female patients (28 premenopausal, 31 postmenopausal). Bone densities of the lumber spine, femoral neck, femoral trochanter and Wards triangle were measured by dual photon absoptiometry and compared with those of age, sex, menopause-matched normal controls. The levels of serum osteocalcin, alkaline phosphatase, calcium, phosphorus were measured in patients and their correlations with bone densities were analyzed. The degree of change in bone density was quantified with Z transformation. Bone densities of lumbar spine and femur were decreased significantly in postmenoausal patients when compared with controls (lumbar spine: 0.8696±0.116 vs. 0.9264±0.043(g/cm²), femoral neck: 0.7246±0.096vs. 0.8020±0.037(g/cm²), femoral trochanter: 0.6021±0.088 vs 0.6489±0.032(g/cm²), Ward's triangle: 0.6216±0.128 vs. 0.6900±0.048(g/cm²), p<0.05) but in premenopausal women, there were no differences in bone densities between patients and controls. Bone densities were negatively correlated with serum ostocalcin (lumbar spine r=-0.572, femoral neck r=-0.561, femoral trochanter r=0.646, Ward's triangle r =-0.581, p<0.001), and alkaline phosphatase (lumbar spine r= -0.615, femoral neck r =-0.610 femoral trochanter r=-0.452, Ward's triangle r=-0.573, p<0.01) and Z value were negatively correlated with osteocalcin (lumber spine r=-0.427 femoral neck r=-0.473 femoral trochanter r=-0,567 Ward's triangle r=-0.464, p<0.01), and patients age (lumbar spine r=-0.464 femeral neck r=-0. 350, femoral trochanter r=-0.425, Ward. triangle r=-0.310, p<0.05). These results suggest that sucblinical hyperthyroidism induced by suppressive thyroxine therapy can cause osteoporosis by high bone turnover which is severer in older postmenoausal women. Therefore regular evaluation of bone mineral density and warning for osteoporosis will be necessary.

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.

이소성 ACTH 생산에 의해 야기된 Cushing 증후군이 동반된 소세포 폐암

곽영임 ( Young Im Kwak ),임영혁 ( Young Hyuck Im ),천영국 ( Young Kug Cheon ),이가희 ( Ka Hee Yi ),남현석 ( Hyeon Seok Nam ),이춘택 ( Choon Taek Lee ),강윤구 ( Yoon Koo Kang ),이진오 ( Jhin Oh Lee ),강태웅 ( Tae Woong Kang ) 대한결핵 및 호흡기학회 1995 Tuberculosis and Respiratory Diseases Vol.42 No.6

대한갑상선학회, 10년, 그리고 미래

박영주 ( Young Joo Park ),송영신 ( Young Shin Song ),이가희 ( Ka Hee Yi ) 대한갑상선학회 2018 International Journal of Thyroidology Vol.11 No.1

The Korean Thyroid Association (KTA) is a multi-disciplinary organization founded by various Korean societies involved in thyroid disease. The KTA has become a foundation stone of the rapid development of the thyroidology in Korea by utilizing the characteristic of multi-discipline for the past 10 years. On February 16, 2008, the inaugural conference was held with great success. Since then, in a short period of 10 years, the number of lifetime members of the KTA reached 623. On March 29, 2012, the KTA became an approved organization by Korean Medical Association within the record time of 4 years after its establishment. In terms of patient care, mutual cooperation among experts in the various fields of thyroid disease have been promoted based on the KTA. On the academic side, the number of papers were awarded and published at international conferences or international academic journals has increased dramatically, and finally, the research on thyroid disease in Korea has reached the global level. The KTA is a multi-disciplinary society consisting of experts from various fields such as internal medicine, surgery, otolaryngology, nuclear medicine, radiology, and pathology. The reason why the KTA has achieved unparalleled growth is that all the KTA members, including senior professors who served as the president and vice president, and incumbent executives, have been harmonized and developed together. Here, we review the activities of the KTA for 10 years from its establishment, and present the future direction of the KTA.

갑상선 세포의 성장에 대한 TSH 및 IGF - I 의 신호전달 과정에서 백일해 독소 예민성 G - 단백의 역할

조보연(Bo Youn Cho),이동수(Dong Soo Lee),이가희(Ka Hee Yi),송민호(Min Ho Shong),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min) 대한내과학회 1991 대한내과학회지 Vol.41 No.1

N/A To evaluate the effect of pertussis toxin sensitive G-proteins on the growth of thyrocytes by TSH and IGF-I, we measured 3H-thymidine incorporation into FRTL-5 cells stimulated by TSH and/or IGF-I. Thymidine incorporation into FRTL-5 cells by TSH(1 mU/ml) or IGF-I (10 ng/ml) was significantly inhibited by the pretreatment of pertussis toxin (25 ug/ml). Adenosine (1mM) inhibited both TSH-and IGF-I- stimulated thymidine incorporation into FRTL-5 cells and the synergistic effect of TSH and IGF-I. This inhibitory effect of adenosine on TSH-or 1GF-I-stimulated thymidine incorporation was blocked partially by the pretreatment of pertussis toxin. However, the inhibition of the synergism of TSH and IGF-I by adenosine was not altered by the pretreatment of pertussis toxin. Indomethacin (100 uM) inhibited TSH effects by 60% and inhibieed IGF-1 effects by 5096 at 24 hours of incubation and then enhanced IGF-I effects in the prolonged incubation. Indomethacin blunted the synergism of TSH and IGF-I. These inhibitory effects of indomethacin were altered by the pretreatment of pertussis toxin. The pretreatment of pertussis toxin did not affect the inhibitory effect of indomethacin on the synergism of TSH and IGF-I at 24 hours of incubation. However, in the prolonged incubation (72 hours) the pretreatment of pertussis toxin significantly blocked the indomethacin effect. These findings suggest that pertussis toxin-sensitive G-proteins are involved in the signal transduction of TSH and/or IGF-1-stimulated growth of FRTL-5 cells and arachidonate metabolites should be involved in the mediation of synergism of growth stimulation induced by TSH and IGF-l in FRTL-5 cells.

세침흡인생검으로 진단한 결핵성 Addison 씨병 1 예

김지영,최형석,이가희,전호춘,김경영,차성은,손인 대한내분비학회 1995 Endocrinology and metabolism Vol.10 No.3

We reported a case of Addison's disease due to tuberculosis, which was pathologically confirmed by fine-needle aspiration biopsy. In a 39-year-old man with fatigue, weakness, and generalized cutaneous pigmentation, the diagnosis of Addison's disease was made by the finding of elevated plasma ACTH level and subnormal response to rapid ACTH test. Computed tomographic scan revealed bilateral adrenal mass with heterogenous uptake and peripheral rim enhancement, and calcification. Ultrasoundguided fine-deedle aspiration biopsy of the left adrenal mass disclosed granulomatous inflammation with caseation necrosis. The patient also had active tuberculosis in the right inguinal lymph node(J Kor Soc Endocrinol 10: 296-310, 1995).