갑상선 결절의 임상양상과 미세침흡인검사의 의의

원진호,한희정,채수홍,김현진,송민호,김영건 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

We evaluated clinical manifestation of nodular thyroid disease and fine-needle aspiration cytology results to establish an appropriate diagnostic approach to thyroid nodule. We examined 594 patients who visited Chungnam National University Hospital with one or more thyroid nodules between Jan. 1996 and Dec. 1998. Fine-needle aspiration cytology was carried out after clinical evaluation including medical history, physical examination(hardness,size, multinodularity,fixation) and laboratory test(scan, thyroid function test). Among the 594 cases, 53 cases(8.9%) were diagnosed as cancer and 457 cases(77%) were diagnosed as benign nodule. None of these factors - age, sex. soft and firm nodule, multinodularity, thyroid scan, thyroid sonography, and thyroid function test - were significant to predict cancer in our study. The prevalence of cancer was significantly higher in hard nodule(28. 5%,39/137) than firm(3.8%,12/316) or soft nodule(0%,0/72). There was size difference between malignant(24.2±62.8ml) and benign nodules(12.6±26.1ml),but the size difference wasn't shown to an indicator to say whether malignant or benign. The prevalence of cancer in relation to fixation was significantly higher in fixation(50%,19/38) and partial fixation nodule(33%,4/12) than movable nodules(5.8%,28/476). Rapid growing, vocal cord palsy,and lymphadenopathy among the medical history had higher relative risk to cancer (relative risk= 14, 4.8, 10.2. respectively). We also examined 67 cases which were diagnosed by histology after operation and, through comparison between the results of histology and cytology., evaluated the effectiveness of fine-needle aspiration cytology. Sensitivity, specificity, false negative rate, and false positive rate of fine-needle aspiration cytology were 92-100%, 47-63%, 0-20%, 0-50%,respectively. Our data suggests that thyroid nodules of the patients which are characterized firm, fixed, rapid growing, lymphadenopathy, and vocal cord palsy require more careful evaluation for thyroid cancer. We also recommand thyroid aspiration cytology in first step evaluation to rule out thyroid cancer.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: is it Necessary to Use Local Anesthesia for the Application of One Needle Puncture?

김동욱,김기남,노명호 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.5

Objective: This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. Materials and Methods: A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). Results: The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001). Conclusion: In our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia. Objective: This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. Materials and Methods: A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). Results: The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001). Conclusion: In our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia.

Graves병에서 발생한 갑상선 암

권수경,임동현,강상중,김성만,최영식,박요한 고신대학교 의학부 2000 高神大學校 醫學部 論文集 Vol.15 No.1

Background Thyroid nodules in patients with Graves' disease are common and raise concern about coexistent thyroid malignancy. Furthermore, it was reported that thyroid cancers in patients with Graves' disease were more aggressive than those without. Thus, it is important to detect thyroid cancer in the patients with Graves' disease prior to surgery. However, there has been no standard guideline suggested for the management of thyroid nodules in the Graves' disease. Therefore, we tried to characterize thyroid nodules associated with Graves' disease and to assess the usefulness of ultrasonography and high resolution ultrasound-guided fine needle aspiration (FNA) in the management of thyroid nodules associated with Graves' disease. Methods Sixty-five patients were included in the study who underwent high resolution ultrasound-guided FNA for thyroid nodules of the 341 patients with Graves' disease at Kosin Medical Center from June, 1996 to January, 1999. Thyroid nodules were classified according to the internal echo pattern, numbers and the size of nodule. Results Thyroid nodules occurred in 19.1% of patients with Graves' disease. The age of the patients with nodules distributed evenly through third to seventh decade (18-68 years, mean 43 years). Thyroid nodules occurred evenly between third decade seventh decade. Male to female ratio was 1:4.09. Thyroid cancers occurred in 6 patients (9.2%) of nodules, and was 1.76% of the total Graves' patients. Eight cases underwent operation. Of those 5 were papillary carcinoma and 2 adenomatous goiter, and 1 Hu¨rthle cell carcinoma. Malignant thyroid nodules occur evenly between third decade to seventh decade. The incidence of malignancy was 10.7%(3/28) in solitary nodule and 8.1%(3/37) in multiple nodules. Thirty-six cases (55.4%) were measured 1㎝ or less, 27 cases (41.4%) between 1.0㎝ to 3.0㎝, and 2 cases (0.32%) above 3㎝, and malignant nodules were 3 (11.1%), 2(7.4%), and 1 (50.0%) respectively. The size of malignant nodule ranged between 0.5㎝ and 4.2㎝. Three of malignant nodules were microcarcinoma (≤1㎝) and the smallest one (0.5㎝) metastasized to regional lymph node. Of the 65 nodules, 50 cases were solid, 4 cystic, and 11 mixed. Malignant nodules were more frequent in the solid nodule, but there was no significant difference between each group. The titers of thyrotropin binding inhibitory immunoglobulin(TBⅡ) in the malignant patients were 9.2% to 350.0% and TBⅡ was positive in the 4 of 6 cases of malignacy. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 95.9%. No complication except pain on aspiration site was noted during this study. Conclusion The incidence of thyroid nodule in Graves' patients was high and the rate of malignancy also high in Graves' patients with thyroid nodule. Malignant thyroid nodules occurred relatively evenly through third to seventh decade. Large proportions of malignant nodules were microcarcinomas and even the smallest on of the malignant nodules metastasized to regional lymph node. Therefore, for the proper management of thyroid nodule associated with Graves' disease, it is suggested that ultrasonography be needed to detect thyroid nodule in all Graves' patients, and ultrasound-guided FNA be performed for the diagnosis of small thyroid cancer.

Graves병에서 발생한 갑상선 암

권수경,임동현,강상중,김성만,최영식,박요한 고신대학교 의학부 2000 고신대학교 의학부 학술지 Vol.15 No.1

Graves병에서 발생한 갑상선 암

권수경,임동현,강상중,김성만,최영식,박요한 고신대학교(의대) 고신대학교 의과대학 학술지 2000 고신대학교 의과대학 학술지 Vol.15 No.1

Background : Thyroid nodules in patients with Graves' disease are common and raise concern about coexistent thyroid malignancy. Furthermore, it was reported that thyroid cancers in patients with Graves' disease were more aggressive than those without. Thus, it is important to detect thyroid cancer in the patients with Graves' disease prior to surgery. However, there has been no standard guideline suggested for the management of thyroid nodules in the Graves' disease. Therefore, we tried to characterize thyroid nodules associated with Graves' disease and to assess the usefulness of ultrasonography and high resolution ultrasound-guided fine needle aspiration (FNA) in the management of thyroid nodules associated with Graves' disease. Methods : Sixty-five patients were included in the study who underwent high resolution ultrasound-guided FNA for thyroid nodules of the 341 patients with Graves' disease at Kosin Medical Center from June, 1996 to January, 1999. Thyroid nodules were classified according to the internal echo pattern, numbers and the size of nodule. Results : Thyroid nodules occurred in 19.1% of patients with Graves' disease. The age of the patients with nodules distributed evenly through third to seventh decade (18-68 years, mean 43 years). Thyroid nodules occurred evenly between third decade to seventh decade. Male to female ratio was 1:4.09. Thyroid cancers occurred in 6 patients (9.2%) of nodules, and was 1.76% of the total Graves' patients. Eight cases underwent operation. Of those 5 were papillary carcinoma and adenomatous goiter, and 1 Hurthle cell carcinoma. Malignant thyroid nodules occur evenly between third decade to seventh decade. The incidence of malignancy was 10.7% (3/28) in solitary nodule and 8.1% (3/37) in multiple nodules. Thirty-six cases (55.4%) were measured 1cm or less, 27 cases (41.4%) between 1.0cm to 3.0cm, and 2 cases (0.32%) above 3cm, and malignant nodules were 3 (11.1%), 2 (7.4%) and 1 (50.0%) respectively. The size of malignant nodule ranged between 0.5cm and 4.2cm. Three of malignant nodules were microcarcinoma (≤1cm) and the smallest one (0.5cm) metastasized to regional lymph node. Of the 65 nodules, 50 cases were solid, 4 cystic, and 11 mixed. Malignant nodules were more frequent in the solid nodule, but there was no significant difference between each group. The titers of thyrotropin binding inhibitory immunoglobulin (TBII) in the malignant patients were 9.2% to 350.0% and TBII was positive in the 4 of 6 cases of malignancy. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 95.9%. No complication except pain on aspiration site was noted during this study. Conclusion : The incidence of thyroid nodule in Graves' patients was high and the rate of malignancy also high in Graves' patients with thyroid nodule. Malignant thyroid nodules occurred relatively evenly through third to seventh decade. Large proportions of malignant nodules were microcarcinomas and even the smallest one of the malignant nodules metastasized to regional lymph node. Therefore, for the proper management of thyroid nodule associated with Graves' disease, it is suggested that ultrasonography be needed to detect thyroid nodule in all Graves' patients, and ultrasound-guided FNA be performed for the diagnosis of small thyroid cancer.

갑상선결절내 석회화소견과 갑상선암종과의 연관성

최종욱(Jong Ouck Choi),이재용(Jae Yong Lee),정근(Keun Chung),최건(Geun Choi) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.1

Objectives: Calcification of the thyroid nodule has been reported to have a close relationship with differentiated thyroid carcinoma, however there are limited studies on the relationship between the calcified thyroid nodule and thyroid malignancy. The authors studied the clinical significance of calcification within the thyroid nodule. Materials and Methods: There were total of 60 patients who underwent surgery for calcified thyroid nodules which were identified from plain neck X-ray, ultrasound and computed tomography during the period January 1991 to June 1996 at the Department of Otorhinolaryngology-Head and Neck Surgery of Korea University Hospital. Six patients were not included because of recurrence and previous thyroid surgery. Histopathologic and radiologic analysis was done on the remaining 54 patients. Results: Results showed that 25 of 54 cases(46%) to be malignant histopathologically. Of the 25 malignant cases, papillary carcinoma was the most common with 22 cases followed by 2 cases of undifferentiated carcinoma and I case of medullary carcinoma. Statistically high incidence of malignancy was observed when the consistency of calcified thyroid nodule was solid, shape of calcification was irregular and inhomogenous, and adhesion of calcified thyroid nodule to the regional structure was present. Conclusion: The probability that a thyroid nodule is malignant has been reported to be 3­20%. However, about half of the thyroid nodules with calcification found to be malignant on this study, calcification of the thyroid nodule can be used as a guideline for detecting thyroid malignancy.

중 장년층 남성에서 건강검진 상 발견되는 갑상선 결절의 임상적 특성 및 발생률

전연진(Yeon Jin Jeon),고영택(Young Teag Koh),오승종(Seung Jong Oh),구민영(Min Young Koo) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.4

Purpose: Thyroid nodules are a common disease in clinical practice. The prevalence of thyroid nodules has recently increased according to the development of thyroid ultrasonography. Thyroid nodules are more commonly found in women, but the potential for malignant nodules is much higher in men. The purpose of this study was to assess clinical characteristics and the incidence of thyroid nodules and malignancy in the adult male population. Methods: Clinical characteristics and incidence of thyroid nodules was examined by screening ultrasonography targeting 6,968 male patients over the age of 40 who visited the National Police Hospital from January 2012 and April 2015. Results: Among 6,968 male patients, 2,481 (35.6%) showed abnormal findings on ultrasonography. Of the 2,481 patients, 2,370 patients (34.01%) had a thyroid nodule and 111 patients (4.47%) had thyroiditis without a thyroid nodule, previous thyroidectomy, lymphadenopathy, esophageal diverticulum, parathyroid cyst, and benign calcification. Of the 2,481 patients, 958 patients (38.6%) had abnormal TFT and 204 patients (8.22%) had thyroiditis with or without a thyroid nodule. Thyroid nodules were benign in 1993 (80.33%) cases, indeterminate in 313 (12.61%) cases, and suspicious in 64 (2.56%) cases. Among the 2,481 subjects, thyroid cancer was detected in 37 subjects (1.49%). Conclusion: The incidence of thyroid nodules has recently increased according to the development of thyroid ultrasonography.

중독성 갑상선 결절의 치료에 있어서 수술적 치료의 중요성

박귀숙,오은미,송원종,이영돈,정유승,Guisuk Park,Eun Mee Oh,Won Jong Song,Young Don Lee,Yoo Seung Chung 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.3

Purpose: Autonomous hyperfunctioning thyroid nodules produce thyroid hormone independently of TSH. Of these, toxic thyroid nodules provoke hyperthyroidism and can be treated by surgery or radioactive iodine therapy. The aim of this study was evaluating the role of each treatment method in Korean patients with toxic thyroid nodule. Methods: From July 2008 to June 2013, 10 patients were diagnosed with toxic thyroid nodule. We diagnosed toxic thyroid nodule by thyroid function test and thyroid scan. Thyroid function test showed hyperthyroidism. Hot nodule and suppressed uptake surrounding thyroid tissue was observed on thyroid scan. We analyzed medical records of 10 patients retrospectively. Results: 9 patients were women and 1 patient was man. Median follow-up duration was 22 months. Most common symptom was neck mass (80%) and the median tumor size was 2.66 cm. 99mTc uptake increased by 6.41% on thyroid scan. All 10 patients refused radioactive iodine therapy and 3 of these denied even operation. In 7 patients underwent thyroidectomy, 4 patients were proved having thyroid malignancy (3 papillary thyroid carcinomas and 1 follicular thyroid carcinoma). Conclusion: In Korean patients, toxic thyroid nodule was likely to accompany thyroid malignancy and radioactive iodine therapy is contraindicated in this case. Therefore, we suggested that surgery has to be considered in the first place in treatment of toxic thyroid nodule.

Thyroid Nodule Requiring Thyroidectomy in a Patient with Thyroid Hemiagenesis

Jane Chungyoon Kim,Jong Jin Kim,Ki Tae Hwang,Young Jun Chai 대한갑상선-내분비외과학회 2021 The Koreran journal of Endocrine Surgery Vol.21 No.4

Thyroid hemiagenesis (TH) is a rare congenital disorder in which one lobe of the thyroid gland fails to develop. Since most patients experience no clinical symptoms, TH is typically diagnosed incidentally by taking imaging of neck region. In this paper, we report a case of right lobe TH associated with follicular neoplasm. A 65-year-old woman was referred for surgery for a left thyroid nodule, diagnosed as suspicious for follicular neoplasm on fine needle aspiration biopsy (FNAB). In 2012, the patient underwent screening by neck ultrasonography and was incidentally diagnosed with right TH and a left thyroid nodule. The patient had routine follow up for the thyroid nodule and thyroid function tests, and she was diagnosed for subclinical hypothyroidism which did not require medicated until 2015. The patient took thyroid hormone medication for 2 years (2015-2017), until her thyroid hormone levels normalized. In 2021, follow up FNAB was performed on the left thyroid nodule, and cytologic evaluation revealed that the nodule was suspicious for follicular neoplasm. Preoperative computed tomography scan revealed an absence of the right thyroid gland and TH was incidentally diagnosed. Left thyroid lobectomy was performed on this patient, and during operation, neither of right thyroid gland nor isthmus were found. Post operatively, she was prescribed with levothyroxine medication for thyroid hormone replacement. The pathologic report revealed nodular hyperplasia with Hashimoto thyroiditis. Regular follow up and surveillance of patients with TH is recommended for the early diagnosis of other thyroid diseases.

갑상샘 결절의 진단에서 Galectin-3, MUC1, EGFR 검사의 유용성

안태주,홍종철,박헌수,홍숙희 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.6

Background and ObjectivesZZThe diagnosis of thyroid nodular diseases is critical in clinical management. Fine needle aspiration cytology and ultrasound-guided core needle biopsy are widely considered as diagnostic techniques in assessment of thyroid nodular diseases. Because of the histological similarity of follicular patterned thyroid lesions, the differential diagnosis between some thyroid lesions is often difficult to determine, even with permanent sections. For this reason,we assessed diagnostic usefulness of immunohistochemical staining for the three potential markers of malignant thyroid nodule, Galectin-3, MUC1 and EGFR (Epidermal growth factor receptor)in the tissue obtained by surgery. Subjects and MethodZZThe immunohistochemical expression of galectin-3, MUC1 and EGFR was evaluated in 76 thyroid lesions obtained by surgery to assess their potential as markers in differential diagnosis of thyroid nodule. The following were studied: 20 cases of papillary carcinoma,16 cases of follicular carcinoma, 20 cases of follicular adenoma and 20 cases of adenomatous goiter. ResultsZZThe expression of Galectin-3 was stronger in malignant thyroid nodules, especially in papillary carcinoma, than in benign thyroid nodules. However, there were no significant differences in the expression rates of MUC1 and EGFR between malignant thyroid nodules and benign thyroid nodules. The expression of MUC1 and EGFR was weaker in follicular neoplasm than in other thyroid nodules. ConclusionZZGalectin-3 was a reliable marker for papillary carcinoma. The expression of MUC1and EGFR was increased in the papillary carcinoma and goiter, so if we could selectively identify cytoplasm MUC1, we could distinguish papillary carcinoma from the goiter. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:354-9