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서지혜,제지혜,이현정,나영주,정일우,안지현,김신곤,최동섭,김남훈 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.2
L-thyroxine (LT4) withdrawal prior to radioactive iodine (RAI) ablation therapy is a commonly used method for successful treatment of patients with papillary thyroid cancer (PTC). However, a prolonged period of hypothyroidism induced by LT4 withdrawal is sometimes associated with impaired quality of life and cardiopulmonary dysfunction in PTC patients. Furthermore, LT4 withdrawal may have a trophic effect on residual cancer by means of increased thyrotropin. We report on 2 cases of metastatic PTC patients with malignant pleural effusion (MPE) whose disease showed rapid worsening after LT4 withdrawal and RAI therapy. The first case is a 65-year-old woman who had PTC with multiple distant metastases and MPE. During LT4 withdrawal for RAI therapy, MPE showed rapid worsening, and the patient required repetitive therapeutic thoracentesis. The second case is a 49-year-old woman with PTC who underwent 3 additional operations for cancer recurrence in the neck lymph nodes and 6 times of RAI treatments. While preparing for the 7th RAI treatment by withdrawing LT4, she developed MPE which became progressively aggravated after RAI therapy. Both patients experienced increased pleural effusion during the LT4 withdrawal period and a rise in the thyroglobulin level was observed after RAI therapy. MPE was not controlled with therapeutic thoracentesis and pleurodesis. Eventually, both patients died of rapid disease progression after RAI therapy. In summary, LT4 withdrawal may have an adverse effect on metastatic PTC patients, particularly those with MPE.
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Mutiple Spontaneous Rib Fractures in Patient with Cushing’s Syndrome
이현정,제지혜,서지혜,나영주,유혜진 대한골대사학회 2014 대한골대사학회지 Vol.21 No.4
Glucocorticoid (GC) excess, including Cushing’s syndrome, is a common cause of sec-ondary osteoporosis. Thirty to fifty percent of Cushing’s syndrome patients experiencenon-traumatic fractures, which is often the presenting manifestation of Cushing’s syn-drome. However, there have been rare cases of Cushing’s syndrome diagnosed onlybased upon bone manifestations. We describe a case of Cushing’s syndrome that was di-agnosed in a 44-year-old woman who initially visited our hospital due to multiple non-traumatic rib fractures. She did not exhibit any other manifestations of Cushing’s syn-drome such as moon face, buffalo hump or abdominal striae. Initially, we evaluated herfor bone metastases from a cancer of unknown origin, but there was no evidence ofmetastatic cancer. Instead, we found a left adrenal incidentaloma. As a result of the hor-mone study, she was diagnosed as having Cushing’s syndrome. Interestingly, her bonymanifestation of Cushing’s syndrome, which was evident in the bone scan and bonemineral densitometry, completely recovered after a left adrenalectomy. Therefore, thepossibility of Cushing’s syndrome as a cause of secondary osteoporosis should be con-sidered in young patients with non-traumatic multiple fractures, with or without anyother typical features of Cushing’s syndrome.
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Eileen L. Yoon,연종은,고은정,이현정,제지혜,유양재,강성희,서상준,김지훈,서연석,임형준,변관수 대한의학회 2017 Journal of Korean medical science Vol.32 No.2
The prognostic role of aberrant serum miRNA expression for predicting response to sorafenib treatment in advanced hepatocellular carcinoma (HCC) patients has not been well characterized. We aimed to identify specific serum miRNAs that are associated with positive radiologic responses or improved survival in sorafenib-treated HCC patients. miR-18a, miR-21, miR-139-5p, miR-221, miR-224, and miR-10b-3p, were selected for analysis. Serum samples from 24 patients with advanced stage HCC and 25 patients with liver cirrhosis (LC) were analyzed. All of the miRNAs except miR-21 were found to be upregulated in serum samples from HCC patients. None of the miRNAs assayed differed significantly in terms of expression between the responder and non-responder groups among HCC patients. However, miR-10b-3p levels were significantly higher in the subgroup of HCC patients with worse overall survival (fold change = 5.8, P = 0.008). Serum miRNA-10b-3p was upregulated in the presence of macrovascular invasion (MVI), and those with higher serum miRNA-10b-3p had significantly shorter survival during treatment (P = 0.042). Although no single serum miRNA was predictive of response to sorafenib treatment, analysis of serum miR-10b-3p levels may be valuable for diagnosis of HCC and prediction of survival of sorafenib-treated patients.
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