갑상선 일엽절제시 수술방법에 따른 임상적 비교 고찰

윤태일,안상익,정용식,소의영,Tae Il Yoon,M.D.,Sang Ick Ahn,M.D.,Yong Sik Jung,M.D. and Euy Young Soh,M.D. 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.2

Purpose: The conventional surgical treatment for thyroid disease requires long skin incision with skin flap that can result in prominent scar, parethesia, hypesthesia in the neck. With recent developement in surgical techniques for thyroid tumors, several apporaches have been applied to neck surgery. We performed thyroid operations with 3 different methods and evaluated the role of respective operation method. Methods: Three different surgical methods; conventional, minimally invasive open, and endoscopic thyroidectomy with axillary approach, were performed on 60 patients who were admitted to Ajou medical center from June to December 2003. All patients were diagnosed as having a benighn mass in unilateral lobe of thyroid gland preoperatively by ultrasonography and fine needle aspiration cytology. We compared the clinical results of respective 3 operation methods each other. Results: Hospital stay and the operation time for minimal invasive open thyroidectomy was significantly shorter than those for endoscopic thyroidectomy (P<0.000). Amounts of post operative analgesics were the lowest in minimal invasive open thyroidectomy than other groups (P<0.019). The patients who was treated by using endoscopic procrdure were more satisfied with the cosmetic result. There was no significant complication in three groups. Conclusion: Minimally invasive open thyroidectomy and endoscopic thyroidectomy can be performed safely with cosmetic benefit, and then recommanded as a alternativeoperative method in selected patients. (Korean J Endocrine Surg 2004;4:97-100)

갑상선 자극호르몬이 갑상선암세포의 VEGF, 신생혈관 형성, 성장, 침윤 및 전이에 미치는 영향

소의영,박희붕,김혜진,김현만<SUP>1<,SUP>,Euy Young Soh,M,D,Hee Boong Park,M,D,Hye Jin Kim,M,D,and Hyun Man Kim,M,D,<SUP>1<,SUP> 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.1

Purpose: Vascular endothelial growth factor (VEGF) is a vascular endothelial cell specific mitogen and a major regulator of angiogenesis. VEGF secretion is activated in some thyroid cancers and that VEGF secretion is stimulated by TSH. So we postulated that TSH may promote growth and invasion in some thyroid cancers by stimulating VEGF secretion and angiogenesis. Methods and Results: We investigated the TSH effect for the VEGF secretion, endothelial cell proliferation and invasion in vitro with the primary cultured normal thyroid cell (NT-1) and thyroid cancer cell line (TPC-1). And to evaluate the relationship between TSH and VEGF, angiogenesis and tumor growth in vivo, we xenografted human dermal matrix inoculated with thyroid cells into nude mice or directly injected subcutaneously. For the study, mice were made hypothyroid (Group 1) by antithyroid hormone p.o, hyperthyroid (Group 2) by L-thyroxine injection and euthyroid (Group 3). One week after the treatment, significant difference were noted in T3, T4 and TSH level between each group, but the VEGF level showed significant difference in group 1 only compared with group 2 and 3. NT-1 or TPC-1 were seeded in the upper chamber of Transwell and HUVEC were cultured in lower chamber, and added different concentration of TSH. NT-1 and TPC-1 secreted VEGF under basal condition, but the level were similar. TPC-1 cells secreted significantly more VEGF than NT-1 after TSH (1, 10, 100 mIU/dl) stimulation, which were also parallel with the concentration of TSH. In low concentration of TSH (0, 1 mIU/dl), there were no difference of HUVEC proliferation between NT-1 and TPC 1. In high concentration of TSH (10, 100 mIU/dl), however, TPC-1 enhanced HUVEC proliferation than NT-1 significantly (p<0.05). Similar findings were noted in thyroid cell invasion. Invasion was higher in TPC-1 than in NT-1 in high concentration of TSH (10, 100 mIU/dl). In vivo study using the dermal matrix showed that number of blood vessels ingrowth were higher in Group 1 (25/HPF) than Group 2 (16/HPF) or Group 3 (17/HPF). But there was no difference between Group 2 and Group 3. Level of TSH and VEGF were also increased significantly in Group 1 compared with in Group 2 and Group 3. The size of tumor did not showed significant difference between each group during observation. The tumor from Group 1 (6.2 gm) were larger compared with Group 2 (5.1 gm) or Group 3 (5.6 gm), but this difference was not significant statistically (p>0.05). The number of blood vessels in tumor were also more increased in Group 1 and were commonly located in the peripheral portion of tumor. Conclusion: We conclude that thyroid cancer cell line secrete the VEGF and TSH secretion is more enhanced by the stimulation of TSH. And increased VEGF promote the vascular endothelial cell proliferation, invasion and angiogenesis in thyroid cancer. (Korean J Endocrine Surg 2001; 1:51-60)

분화 갑상선암 수술 후 발생한 불현성 갑상선중독증 환자의 골대사 및 골밀도의 특징

박승현,이잔디,최수윤<SUP>1<,SUP>,소의영,Seung Hyun Park,M,D,Jandee Lee,M,D,Soo Youn Choi,M,D,<SUP>1<,SUP> and Euy-Young Soh,M,D,Ph,D 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.2

<B>Purpose:</B> The clinical implications of long-term suppressive thyroxine (TSH) therapy on the skeletal system are critical, largely because of the favorable prognosis of differentiated thyroid carcinomas (DTC). However, the potentialdeleterious effects of TSH suppressive therapy on the bone metabolism remain controversial. The aim of this prospective study was to assess the effects of chronic L-thyroxine (LT4) treatment with supraphysiologic doses of TSH on the bone mineral density (BMD) and biochemical bone remodeling markers. <B>Methods:</B> This cross-sectional study was designed to compare patients with DTC and who were treated with LT4 for more than 2 years after thyroidectomy with an age-matched and gender-matched healthy control group. A total of 100 female outpatients (mean age: 47.5±13.8; 38 pre and 62 post-menopausal) who were on LT4 for between 2 and 10 yearswere enrolled. One hundred and three age-matched healthy volunteers were recruited as a control group. Laboratory tests were performed to exclude other possible factors for secondary osteoporosis. We measured the BMD by dual energy X-ray absorptiometry (DEXA), and bone turnover was assessed by several biochemical parameters. <B>Results:</B> Our data showed no significant difference between the bone markers for the study group and the control group that had a premenopausal status. However, for the patients with a postmenopausal status, the serum levels of bone alkaline phosphatase were significant higher in the study group than that in the control group (P=0.038). We also found no significant difference between the study patients and the age- and weight-matched controls for the BMD at any site of measurement. <B>Conclusion: </B>This preliminary report suggests that bone turnover and accelerated bone loss might be related to the long-standing TSH suppression in postmenopausal women. Future prospective studies with an increased number of studied patients and a prolonged time of observation will be necessary in order to better assess the relative risk of osteoporosis in patients who are undergoing TSH suppressive treatment. <B>(Ko</B><B></B><B>rean J Endocrine Surg 2008;8:89- 94)</B>

갑상선 미세유두상암에서 혈관내피성장인자(VEGF)와 혈관내피성장인자 수용체(VEGFR-1), 저산소증 유발인자(HIF-1α)의 mRNA 발현

윤태일,정용식,고진철,함기백<SUP>1<.SUP>,소의영,Tae II Yoon,M.D.,Yong Sik Jung,M.D.,Jin Cheol Koe,M.D.,Ki Baek Ham,M.D.<SUP>1<.SUP> and Euy Young Soh,M.D. 대한갑상선-내분비외과학회 2005 The Koreran journal of Endocrine Surgery Vol.5 No.1

Purpose: Angiogeneisis is essential process for tumor growth and metastasis. Vascular endothelial growth factor (VEGF) is major regulator of angiogenesis. Recently, the incidence of papillary thyroid microcarcinoma (PTMC) increased because of development in diagnostic modality. Several recent reports have documented relationship of VEGF and papillary thyroid cancer. The aims of this study were to determine whether angiogenetic phenotype was changed or not changed and to evaluate the relationship between clinicopathologic features and VEGF, vascular endothelial growth factor receptor-1 (VEGFR-1), hypoxic induced factor-1alpha (HIF-1α) mRNA expression in PTMC. Methods: VEGF, VEGFR-1, HIF-1α mRNA expression was examined by RT-PCR in 14 patients who had undergone thyroidectomy due to PTMC. The thyroid tumor tissue and adjacent normal thyroid tissue were collected in operation and preserved at ⁣70<SUP>o</SUP>C in RNA later solution. We evaluate the expression of VEGF, VEGFR-1, HIF-1α mRNA by RT- PCR. The expression of mRNA was quantititated by densitometer and analyzed the relationship between clinicopathologic features and mRNA expression. Results: Compared to normal tissues, in PTMC we observed higher expression of HIF-1α mRNA (P=0.024) and lower expression of VEGF mRNA (P=0.002). There was no difference in expression of VEGFR-1.The patients with nodal metastasis had higher expression of the VEGF mRNA in tumor tissues than those without nodal metastasis but not significantly. The VEGF mRNA of tumor tissues in patients with thyroid capsule invasion or not were expressed similarly. The lower expression of VEGF mRNA were observed more frequently in younger patients (<40). Conclusion: The expression of VEGF mRNA was lower in tumor tissue in spite of higher expression of HIF-1α mRNA. These results suggest that the reason for good prognosis and no progression to clinical cancer in PTMC was related to the unchanged angiogenic phenotype. (Korean J Endocrine Surg 2005;5:18-23)

갑상선 질환(종양)에서 Cyclooxygenase-2의 발현에 대한 연구

이국종,박희붕,김지훈,정용식,주희재<SUP>1<,SUP>,소의영,Kug Jong Lee,M,D,Hee Boong Park,M,D,Ji Hoon Kim,M,D,Yong Sik Jeong,M,D,Hee Jae Joo,M,D,<SUP>1<,SUP> and Euy Young Soh,M,D 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2

Purpose: Thyroid tumor is one of the most common endocrine tumors, and yet little is known about its molecular process of development and progression. Cyclooxygenase (COX)- 2, the inducible form of the COX enzyme for prostaglandin synthesis, is up-regulated in gastrointestinal cancers and is a key mediator of epithelial cell growth. Regular intake of aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) is associated with a decreased incidence of colorectal, esophageal, gastric, and lung cancer. We sought to determine the involvement of COX-2 in human thyroid cancer. Methods: COX-2 protein was assayed in thyroid tissue of 64 which were inflammatory disease and benign tumor and malignant tumor with or without metastasis patients by using immunohistochemistry and Western Blot analysis. Results: COX-2 protein was not expressed in normal thyroid tissue. But COX-2 protein was expressed strongly in inflammatory tissue. Expression of COX-2 was very high in both benign and malignant tumor. There is no difference in pathology and malignant potential or existence of metastasis. Conclusion: There was no correlation between clinicopathological characteristics of thyroid tumor and intensity of COX-2 protein expression. In addition, there was no difference of expression of COX-2 between inflammatory thyroid disease and thyroid tumor. This study indicates that COX-2 protein over expression may contribute to an early event of gastric cancer development, and it further suggests that selective inhibition of COX-2 may provide a chemopreventive effect against thyroid cancer. (Korean J Endocrine Surg 2002;2:90-96)

갑상선 수술시 피대근 절개가 음성에 미치는 영향

고중화,소의영<SUP>1<.SUP>,양해동<SUP>2<.SUP>,전정민,김영주,이승주,Joong-Wha Koh,M.D.,Euy Young Soh,M.D.<SUP>1<.SUP>,Hae-Dong Yang,M.D.<SUP>2<.SUP>,Jeong-Min Chun,M.D.,Youngju Kim,M.D. and Seongju Lee,M.D. 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.2

Purpose: Voice change after thyroidectomy has generally been the result of damage to the recurrent or superior laryngeal nerve. But many patients complain voice alteration without laryngeal nerve injury after thyroidectomy. The purpose of this study is to investigate whether strap muscle division results in any subjective or objective functional sequelae in voice, through long-term follow-up prospectively. Methods: Twenty-two female patients who had undergone thyroid surgery between July 1998 and December 1999, were studied. The patients who were planned for neck dissection, who had benign laryngeal disease or vocal cord paresis, and whose vocal cord paresis were developed after thyroid surgery, were excluded from this study. Twelve patients had undergone thyroidectomy via retraction of strap muscle and ten patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionnaires for changes of voice, acoustics (fundamental frequency, jitter, shimmer, signal to noise ratio, noise to harmonic ratio, voice range), and aerodynamic (maximal phonation time) analyses were done. Results: The subjective voice symptoms after thyroidectomy were disturbances of high pitch, singing, loud voice, and easy fatigue at phonation. There were no significant differences in voice parameters on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group through long-term follow-up. Conclusion: We conclude that strap muscle division does not result in any subjective or objective functional problems in voice. We suggest that surgical division and reconstruction of these muscles should be employed routinely when opera-ting on large, toxic or neoplastic glands. (Korean J Endocrine Surg 2001;1:237-243)