분화성 갑상선암의 임상적 평가

정성후,Sung Hoo Jung,M,D 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.1

Purpose: Thyroid cancer is the most common endocrine malignancy, and it has a wide spectrum of biologic behavior, histologic appearance, and management. This study reviewed various aspects of the clinical features of differentiated thyroid cancer. Methods: We retrospectively reviewed the clinical characteristics of 114 patients who had undergone surgical management for differentiated thyroid cancer at the Chonbuk National University Hospital from September 1989 to December 1997. Results: The most prevalent age group was in the 5th decade (29 cases, 25.4%). The male-to-female ratio was 1 to 5.7. The most common initial symptom was a palpable mass on the anterior or the lateral portion of the neck (110 cases, 96.5%). The most common duration of illness from the appearance of the symptom to the treatment was below 3 months (38 cases, 34.5%). The primary tumors were located on the right lobe (49 cases, 43.0%), the left lobe (38 cases, 33.3%), both lobes (22 cases, 19.3%), and the isthmus (5 cases, 4.4%). In the histopathologic study, the common type was a papillary carcinoma (102 cases, 89.5%). The common surgical procedures were a total thyroidectomy (66 cases, 57.8%) and a near total thyroidectomy (24 cases, 21.0%). Seventy-five patients (65.8%) received a lymph-noe dissection, and there was cervical lymph-node metastasis in 43 cases (57.3%) of this group. Postoperative complications occurred in 11 cases (9.3%). The common complications were hemorrhage or seroma (5 cases, 4.4%), hoarseness (5 cases, 4.4%) and wound infection (1 cases, 0.9%). Although hypoparathyroidism was predicted, the predominant symptoms did not appear. Regional recurrence or distant metastases were present in 13 cases (11.4%) during four years. Conclusion: Thyroid cancer has a wide sectrum of biological behavior and also problems including the lack of reliable prognostic factors and objective assessments of therapeutic modalities. Appropriate and aggressive management should be recommended because most of differentiated thyroid cancer has a favorable prognosis. (Korean J Endocrine Surg 2002;2:19-24)

갑상선 분화암 수술 후 저용량 방사성 옥소(I-131)요법

정성후,정연준,유희철,강남부,Sung Hoo Jung,M,D,Yeon Jun Jeong,M,D,Hee Chul Yu,M,D,and Nam Poo Kang,M,D 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.1

Purpose: To assess the effectiveness of low-dose (30 mCi) I-131 ablation therapy for remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer. Methods: Between March 1995 and December 1997, 48 patients were given ablative doses (30 mCi) of I-131 following total thyroidectomy for differentiated thyroid cancer in the presence of I-131 uptake in remnant thyroid tissue. The effective ablation of remnant thyroid tissue was determined using a subsequent I-131 whole body scan. If any remnant thyroid tissue remained, we repeated the same management protocol at 6-month intervals. Results: Thirty-eight (79.1%) patients displayed papillary, 8 (16.7%) follicular, 1 (2.1%) medullary and 1 (2.1%) Hurthle cell type cancer. Forty-eight patients underwent total thyroidectomy, 35 cases of which underwent central neck dissection, and 14 cases modified radical neck dissection. Postoperative complication developed in 8 cases, including 4 cases of transient hypoparathyroidism, 1 case of permanent hypoparathyroidism, 2 cases of transient recurrent laryngeal nerve palsy, and 1 case of wound hematoma. There was significant remnant thyroid tissue detected in 46 cases (95.8%) following total thyroidectomy, which were able to be ablated by low dose (30 mCi) I-131. There was no statistical difference between the operative procedures or the numbers of treatment of I-131. Conclusion: This data suggests that low-dose (30 mCi) I- 131 therapy is effective for the ablation of remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer. (Korean J Endocrine Surg 2001;1:98-103)

순수 유두 갑상선암과 소포 변이 유두 갑상선암: 임상병리학적 특성 비교 연구

이병길,윤현조,정성후,Byoung Kil Lee,M.D.,Hyun Jo Youn,M.D. and Sung Hoo Jung,M.D. 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.1

Purpose: Pure papillary thyroid carcinoma (PPTC) and the follicular variant of papillary thyroid carcinoma (FVPTC) are the most common subtypes of papillary thyroid carcinoma (PTC). The aim of this study was to investigate if there are any differences in clinicopathological features of these two subgroups. Methods: We performed a retrospective chart review of patients who were treated for PPTC and FVPTC between September 2003 and April 2008. Four hundred fifty patients were shown to have PPTC (91.8%) and forty (8.2%) had FVPTC after a histologic review. The two groups were compared in terms of the clinicopathologic features and the results of preoperative ultrasonography (USG), the fine needle aspiration cytology (FNAC), the frozen section biopsy and the surgical treatment. Results: The tumor size was significantly larger in the FVPTC group than in the PPTC group (1.47 cm versus 1.08 cm, respectively P=0.024). However, both groups had similar clinicopathologic features in terms of age, gender, capsular invasion, multifocality, lymph node metastasis, the MACIS score and the TNM stage. Further, the operative method did not differ between the two groups. The sensitivities of USG and frozen section biopsy for diagnosing FVPTC were significantly lower than those for PPTC (53.85% versus 72.95%, respectively, P=0.045, 81.58% versus 97.25%, respectively, P=0.049). Conclusion: The FVPTC group presented with a larger tumor size, and the clinicopathologic features of the FVPTC group did not significantly differ from those of the PPTC group. Although further studies with longer follow-up are required, these results suggest that the patients in both groups should be treated identically. (Korean J Endocrine Surg 2009;9:19-23)

갑상선 수술 중 발생한 의도하지 않은 부갑상선 절제의 위험 인자와 임상적 결과

이미숙,이병길,윤현조,정성후,Mi Suk Yi,M.D.,Byoung Kil Lee,M.D.,Hyun Jo Youn,M.D. and Sung Hoo Jung,M.D. 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.1

Purpose: Incidental resection of parathyroid gland is not uncommon during thyroid surgery and may occur even in experienced thyroid surgeons. The aim of this study was to investigate the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. Methods: A retrospective review of patients who underwent thyroid surgery between January and December 2008 was carried out. Pathologic reports were reviewed for the presence of parathyroid tissue in resected thyroid specimen. Two groups of patients were studied: a group with incidental parathyroidectomy (Group A) and without incidental parathyroidectomy (Group B). Results: Three hundred and thirty-four thyroid surgery were performed: 194 total thyroidectomies, 18 near- or subtotal thyroidectomies, 44 lobectomies, 23 endoscopic total thyroidectomies, 55 endoscopic lobectomies. Of these, 265 patients (79.3%) were preformed for malignant disease. Incidental parathyroidectomy occurred in 30.5% (102/334) of thyroid surgery. Risk factors for incidental parathyroidectomy included malignant pathology (P<0.001), operation method (P<0.001), lymph node dissection (P<0.001), and extrathyroidal invasion (P=0.001). Biochemical hypocalcemia was defined as a serum calcium levels less than 8.4 mg/dL. Symptomatic hypocalcemia was defined as patient had tingled sense or spasm of muscle and need to add more calcium replacement. In group A, 86 patients (93.5%) had a biochemical hypocalcemia (P=0.001). Symptomatic hypocalcemia developed in 35.3% (36/102) of group A, compared to 20.7% (48/232) in group B (P=0.005). Conclusion: Malignant pathology, total thyroidectomy, lymph node dissection, and extrathyroidal invasion were associated with a significantly higher risk of incidental parathyroidectomy during thyroid surgery. Incidental parathyroidectomy resulted in biochemical and symptomatic postoperative hypocalcemia. This study suggests that incidental parathyroidectomy may be a potential complication; therefore, parathyroid glands should be identified and preserved with more meticulous inspection during thyroid surgery. (Korean J Endocrine Surg 2011;11:22-27)