갑상선 질환의 방사성요오드 치료와 이차암 발생

이재태,홍채문,하정희 대한갑상선학회 2023 International Journal of Thyroidology Vol.16 No.1

Radioiodine has been effectively applied for the management of hyperthyroidism and differentiated thyroid cancers in most countries of the world. The majority of thyroid cancers are differentiated thyroid cancer that has an overall excellent prognosis, which attributed to appropriate treatment of the disease including administration of radioiodine, I-131. I-131 therapy has usually been undertaken for the ablation of remnant tissue or adjuvant treatment after surgical resection of the thyroid. I-131 therapy was routinely recommended for patients with high-risk disease, and should be considered for intermediate-risk disease as an adjuvant purpose. Several latest studies refute worries of increase cancer risk with I-131 treatment for thyroid cancer. Thus, recent ATA guidelines have shifted toward a more individual and stratified approach, because of benign nature of the differentiated thyroid cancer as well as awareness of side effects including potential increasing incidence of second primary malignancy after I-131 treatment. While some retrospective studies also pointed out that potential increases in cancer development after I-131 treatment for hyperthyroidism recently. Treatment decisions regarding the use of radioiodine therapy should consider the balance of risks and benefits for individual patients with low risk differentiated thyroid cancer and hyperthyroidism, if it is true. Thus, we will review current understanding for the association of increased secondary malignancy and I-131 treatment of thyroid diseases.

대한갑상선학회 갑상선분화암 진료권고안; Part I. 갑상선분화암의 초기치료 - 제5장 갑상선분화암의 수술 후 초기 질병 상태와 재발위험도 평가 및 초기위험군 분류 2024

이은경 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

The American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging classification of thyroid cancer can predict death but cannot determine the type and frequency of follow-up testing. Risk stratification is a concept proposed by the American Thyroid Association that uses additional prognostic factors that are not included in the AJCC/UICC classification, such as number or size of metastatic lymph nodes, genetic mutations, and vascular invasion in follicular cancer, to further refine the prognosis of thyroid cancer. The risk of recurrence was categorized as low, intermediate, and high risk, and the need for total thyroidectomy, radioiodine therapy, or thyroid-stimulating hormone suppression was determined depending on each risk level. This approach has been accepted worldwide, and the previous recommendations of the Korean Thyroid Association followed a similar line of thinking but these have been modified in the revised 2024 guidelines. For the revised initial risk stratification, after careful review of the results of the recent meta-analyses and large observational studies and after a multidisciplinary meeting, four major changes were made: 1) thyroid cancer was reclassified according to the World Health Organization (WHO) 2022 tumor classification system; 2) recurrence risk was stratified by combining encapsulated follicular variant papillary thyroid cancer, follicular thyroid cancer, and oncocytic thyroid cancer, which have similar recurrence risk and associated factors, into follicular-patterned tumor; 3) low-risk groups were defined as those with a known recurrence rate of ≤5%, high-risk groups were upgraded to those with a known recurrence rate of ≥30%, and intermediate-risk groups were those with a recurrence risk of 5–30%; and 4) the intermediate risk group had the recurrence rate presented according to various clinicopathological factors, mainly based on reports from Korea. Thus, it is recommended to evaluate the initial risk group by predicting the recurrence rate by combining each clinical factor in individual patients, rather than applying the recurrence rate caused by single risk factor.

Differentiated Thyroid Carcinoma Risk Factors in French Polynesia

Xhaard, Constance,Ren, Yan,Clero, Enora,Maillard, Stephane,Brindel, Pauline,Rachedi, Frederique,Boissin, Jean-Louis,Sebbag, Joseph,Shan, Larrys,Bost-Bezeaud, Frederique,Petitdidier, Patrick,Drozdovitc Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.6

Background: To investigate differentiated thyroid cancer risk factors in natives of French Polynesia is of interest because of the very high incidence of this cancer in the archipelago. Materials and Methods: To assess the role of various potential risk factors of thyroid cancer in the natives of French Polynesia we performed a case-control study. The study included almost all the French Polynesians diagnosed with differentiated thyroid carcinoma between 1981 and 2003 (n=229) and 373 French Polynesian control individuals from the general population without cancer. Results: Thyroid radiation dose received from nuclear fallout before the age of 15, a personal history of neck or/and head medical irradiation, obesity, tallness, large number of children, an artificial menopause, a familial history of thyroid cancer, a low dietary iodine intake, and having a spring as the main source of drinking water were found to be significant risk factors. No roles of smoking habits, alcohol consumption, iodine containing drugs, and exposure to pesticides were evidenced. Conclusions: Except for smoking, differentiated thyroid carcinoma risk factors in natives of French Polynesia are similar to those in other populations. Our finding on the role of having a spring as a drinking water origin is coherent with some other studies and could be due to geological factors.

분화성 갑상선암의 갑상선 절제술과 림프절 절제술 범위의 결정

이영돈 ( Young-don Lee ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2

Most patients with papillary thyroid cancer (PTC) are low risk and have an excellent prognosis. But in low-risk patients with PTC the extension of thyroidectomy and neck node dissection remains controversial. To date, no randomized, prospective trial comparing survival duration and recurrence rates after thyroid lobectomy and total thyroidectomy has been performed. Proponents of thyroid lobectomy assert that for most patients younger than the age of 40 to 50 years with tumors confined to the thyroid gland the higher complication rates after total thyroidectomy outweigh their potential benefits with respect to disease-free and overall survival. Those who favor total thyroidectomy emphasize advantages such as clearing microscopic contralateral disease, enabling the use of radioactive iodine as an adjuvant therapy, allowing accurate postoperative thyroglobulin surveillance and possibly providing better survival. Therefore the treatment decisions should be based on risk group analysis. The understanding of the prognostic factors and risk groups is crucial in the management of well differentiated thyroid cancer. The important prognostic factors are age, grade of tumor, extrathyroidal extension, size of tumor, and distant metastases. Most consensus guidelines recommend total thyroidectomy as the preferred initial procedure for patients with PTC, with absolute indications including a past history of radiation exposure, familial thyroid cancer, known extrathyroidal extension, cervical lymph node or distant metastasis, tumor size >4 cm, and an aggressive histologic variant of papillary thyroid cancer. In addition to thyroidectomy, lateral neck dissection should be done for palpable or biopsy-positive lymph nodes identified on the preoperative ultrasound. Even though up to 80% of patients will have at least microscopic metastatic spread to cervical lymph nodes, this does not seem to affect prognosis, at least in patients younger than 45 years, and prophylactic lateral neck dissection for patients with papillary thyroid cancer is not recommended. Evidence based recommendations support the application of central lymph node dissection (CLND) at the initial operation for differentiated thyroid cancer in expert hands. CLND may decrease recurrence of PTC and likely improves disease-specific survival because reoperation in the central neck compartment for recurrent PTC may increase the risk of hypoparathyroidism and unintentional nerve injury.

대한갑상선학회 갑상선분화암 진료권고안; 개요 및 요약 2024

박영주 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

Differentiated thyroid cancer demonstrates a wide range of clinical presentations, from very indolent cases to those with an aggressive prognosis. Therefore, diagnosing and treating each cancer appropriately based on its risk status is important. The Korean Thyroid Association (KTA) has provided and amended the clinical guidelines for thyroid cancer management since 2007. The main changes in this revised 2024 guideline include 1) individualization of surgical extent according to pathological tests and clinical findings, 2) application of active surveillance in low-risk papillary thyroid microcarcinoma, 3) indications for minimally invasive surgery, 4) adoption of World Health Organization pathological diagnostic criteria and definition of terminology in Korean, 5) update on literature evidence of recurrence risk for initial risk stratification, 6) addition of the role of molecular testing, 7) addition of definition of initial risk stratification and targeting thyroid stimulating hormone (TSH) concentrations according to ongoing risk stratification (ORS), 8) addition of treatment of perioperative hypoparathyroidism, 9) update on systemic chemotherapy, and 10) addition of treatment for pediatric patients with thyroid cancer.

갑상선질환에서 골건강 평가 및 관리 권고안

홍아람,안화영,김부경,안성희,박소영,김민희,이정민,조선욱,강호철 대한갑상선학회 2022 International Journal of Thyroidology Vol.15 No.1

Thyroid hormones have an important physiological role in maintaining adult bone structure and strength. Therefore, thyroid dysfunction is inevitably associated with various degrees of skeletal consequences. Endogenousovert hyperthyroidism is an established cause of high bone turnover with accelerated bone loss, resulting inosteoporosis and an increased risk of fractures. Hyperthyroidism induced by thyroid stimulating hormonesuppression therapy in patients with differentiated thyroid cancer also has emerged as a contributing factor toosteoporosis and fragility fractures. While, there is lack of evidence that hypothyroidism negatively affects bonehealth. Although there is growing clinical evidence of the importance of bone health in hyperthyroidism, clinicalguidelines on how to evaluate and manage bone health in these diseases have not yet been published worldwide. The Task Force from the Korean Thyroid Association Committee of Clinical Practice Guideline has developed thisposition statement for the evaluation and management of bone health in patients with thyroid diseases,particularly focused on endogenous hyperthyroidism and thyroid stimulating hormone suppression therapyassociatedhyperthyroidism in patients with differentiated thyroid cancer.

갑상선 분화암 수술 후 저용량 방사성 옥소(I-131)요법

최정진(Chung Jin Choi),정성후(Sung Hoo Jung) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.2

Objectives: To assess the effectiveness of the low-dose(30mCi) I-131 ablation therapy for remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer. Methods: Between March 1995 and December 1997, forty-eight patients were given ablative doses(30mCi) of I-131 after total thyroidectomy for differentiated thyroid cancer in the presence of I-131 uptake in remnant thyroid tissue. Effective ablation of remnant thyroid tissue was determined by following I-131 whole body scan. if remnant thyroid tissue remained, we repeated the same management at 6 months interval. Results: Thirty-eight(79.1%) patients had papillary, 8(16.7%) follicular, 1(2.1%) medullary and 1(2.1%) Hurthle cell type cancer. Forty-eight patients underwent total thyroidectomy, among those central neck dissection was performed in 35 cases, and modified radical neck dissection in 14 cases. Postoperative complication developed in 8 cases, which included 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 were significant remnant thyroid tissue in 46 cases(95.8%) of patients after total thyroidectomy, which could be ablated by low dose(30mCi) I-131. There were no statistical difference between operative procedures and number of treatment of I-131. Conclusions: These results suggested that repeated low-dose(30mCi) I-131 therapy would be needed, therefore, high -dose I-131 therapy could be considered as ablation therapy for the remnant thyroid tissue after total thyroidectomy for differentiated thyroid cancer.

분화성 갑상선암에서 수술 후 I - 131을 이용한 잔여 갑상선 조직의 제거 성적

조보연(Bo Yeon Cho),고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(Jung Key Chung),이동수(Dong Soo Lee),김유경(Yu Kyeong Kim),정재민(Jae Min Jeong) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.3

N/A To evaluate the effectiveness of I-131 in ablation of residual thyroid tissue, we analyzed 350 patients with thyroid cancer who were treated with various doses of I-131 after surgery for thyroid cancer. Two hundred fifty five patients were treated with l.lGBq(30mCi) of I-131 for ablation of remnant thyroid and one hundred seventeen patients received more than 2.8GBq(75mCi) of I-131. We determined the effectiveness of ablation by following I-131 whole body scan. Absent visible uptake or minimal uptake in thyroid tissue were considered as successful ablation. Of 255 patients who received doses of 30mCi I-131 therapy, 131 patients(51%) showed successful ablation of residual thyroid tissue with 2.6±1.7 times of I-131 therapy. Of 117 patients who received doses of the more than 75mCi I-131, 84 patients(72%) had successful remnant thyroid ablation with 1.6±1.1 times of I-131 therapy. According to the extent of surgery, successful ablation rates were 78%, 62%, 54%, 33% in patients who underwent total thyroidectomy, subtotal thyroidectomy, lobectomy and isthmectomy, lobectomy or tumorectomy, respectively. This study showed that ablation of remnant thyroid after surgery with 30mCi I-131 was successful only in 50%. Therefore, in cases of patients with high risk for recurrence, we recommend high dose I-131 for ablation of remnant after total thyroidectomy.

저분화암 및 미분화암 치료의 난제

이정훈,소의영 대한갑상선학회 2011 International Journal of Thyroidology Vol.4 No.2

Poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC) have poor prognosis and rare incidence compared to well differentiate thyroid cancer. Since the original description of PDTC in 1983, PDTC was introduced as a separate entity in the 2004 WHO Classification of Endocrine Tumors. PDTC was defined as a thyroid cancer with thyroglobulin-producing non-follicular non-papillary growth pattern and high-grade features, having an intermediate behavior between well differentiated thyroid cancer (WDTC) and ATC. But the criteria of PDTC are still controversial and heterogeneously applied in the diagnostic practice. Also the modalities of treatment, such as the extent of thyroid surgery, the use of radioiodine therapy and external radiation therapy are still controversial. ATC is rapidly progressing human carcinoma with a median survival of 4 to 12 months after diagnosis. Although the complete resection combined with external radiation therapy was reported to be effective recently and multimodality treatment has been recommended, current treatment of ATC has not been adequate for controlling the diseases. Therefore there are new attempts for treatment, such as chemotherapy with paclitaxel, clinical trials of combretastatin 4 phosphate and CS-7107 and multitargeted therapy of bevacizumab with doxorubicin, sorafenib, sunitinib etc. PDTC and ATC are an unexplored field like this, therefore, the studies for molecular pathology and therapeutic approach are necessary for improving survival and quality of life of patients.

소아 분화 갑상선암의 15년 이상의 추적 관찰

김아람,성치원,박영삼,김철승,김갑태,A Ram Kim,M.D.,Chi Won Sung,M.D.,Young Sam Park,M.D.,Cheol Seung Kim,M.D.,Ph.D. and Kab Tae Kim,M.D.,Ph.D. 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.1

Purpose: Thyroid cancer is rare in childhood. Although thyroid cancer is biologically more aggressive in children because of the high incidence of lymph node metastasis and distant metastasis when compared with that of adults, the prognosis is better. This study investigated the prognosis of pediatric differentiated thyroid cancer with 15 years or greater follow-up and we consider the proper treatment of pediatric differentiated thyroid cancer. Methods: From January, 1979 to December, 1994 during 16 years, 17 patients younger than 17 years old and who underwent thyroid surgery for well differentiated thyroid cancer at the Department of Surgery at Presbyterian Medical Center were retrospectively reviewed by the medical records and they were interviewed by telephone. Results: Total thyroidectomy was performed in 4 patients (23.5%), subtotal thyroidectomy was performed in 10 patients (58.8%) and lobectomy was performed in 3 patients (17.7%). The mean follow-up period was 23.5 years (range: 15∼28.2 years) and recurrence was found in 7 cases (41.3%). Five cases (29.5%) showed locoregional recurrence and 2 cases (11.8%) showed distant metastasis. Postoperative radioiodine (<SUP>131</SUP>I) therapy was done in 6 cases (35%) and 6 cases (35%) underwent radioiodine therapy as a therapeutic modality for metastasis. Conclusion: The pediatric well differentiated thyroid cancer in this study showed high rates of lymph node metastasis at the time of diagnosis and a high recurrence rate, but the prognosis was good (100% overall survival rate during the follow-up period). Therefore, total thyroidectomy, radical lymph node dissection and postoperative radioiodine therapy are considered the initial patient management. This aggressive therapeutic management can decrease of the recurrence rate and increase the therapeutic effect. A radioiodine scan and thyroglobulin can used for follow-up. (Korean J Endocrine Surg 2010;10:34-38)