대한갑상선학회의 역사와 갑상선암진단과 치료에 대한 최근 논쟁에 관한 고찰

이광우 대한갑상선학회 2015 International Journal of Thyroidology Vol.8 No.1

It is an undeniable fact that the establishment of the Korean Thyroid Association (KTA) in 2008 will reinforce growing thyroidology in Korea. It is worthwhile to recall the histories behind the foundation of the KTA and to remember the efforts of the founders. Since 2005, there has been a massive increase in thyroid cancer incidence in Korea, which is much higher than in other countries. A large majority of cases fall into papillary microcarcinoma (less than 1 cm). Much debate has been sparked since early 2014 through mass media as well as among medical professionals on the issues of early screening and detection of small thyroid cancer, overdiagnosis and overtreatment of thyroid cancer. Based on the author's past 30 years of clinical practice in endocrinology with a focus on thyroid disease, this article presents my opinion on such debate and provides thoughts on future directions. This article only represents the author’s personal, possibly limited, perspective thought. For this reason, readers are recommended to use their own judgement in weighing the opinions.

예민한 갑상선 자가항체 검사의 해석

김보현 ( Bo Hyun Kim ),김인주 ( In Ju Kim ) 대한갑상선학회 2009 International Journal of Thyroidology Vol.2 No.2

갑상선 자가항체의 측정은 예민한 검사 방법의 개발로 인해 만성 자가면역성 갑상선염이나 그레이브스병 환자의 진단에 임상적으로 유용하게 이용되고 있다. Anti-TPO 항체의 측정은 만성 자가면역성 갑상선염이 의심되는 환자에서 Anti-Tg 항체보다 더 의미 있게 이용되며 임신한 여성에서 산후 갑상선염의 위험도를 예측하는데도 도움이 된다. Anti-Tg 항체의 측정은 만성 자가면역성 갑상선염이 특히 의심이 되나 Anti-TPO 항체가 정상인 경우 적응이 된다. 또한 갑상선암 환자의 수술 후 경과 관찰 중에 Anti-Tg 항체와 Thyroglobulin을 같이 측정하여야 한다. TBII의 측정은 다양한 측정 방법이 있으며 그레이브스병의 진단 및 Euthyroid Graves’ disease의 진단에 유용하며 그레이브스병을 가진 임신부 혹은 자가면역성 갑상선염 환자에서 신생아의 갑상선 기능항진증 혹은 기능저하증을 평가하는데 이용된다. 1세대 TBII측정법에 비해 2세대 및 3세대 측정법이 진단의 예민도는 크게 향상되어 향후 임상에서 널리 이용될 것으로 여겨진다. 하지만, 항갑상선제 치료 종료 시점에 TBII 활성이 관해 및 재발을 예측하는데 있어서 2세대 TBII 측정법이 더 우수한 검사인지는 추가 연구가 필요할 것으로 보인다. 최근 개발된 3세대 TBII측정법이 2세대 TBII 측정법보다 예민도와 특이도가 높다고 보고되고 있지만 이 또한 항갑상선제 복용 후 재발 및 관해를 예측하는데 있어서 1세대 및 2세대 측정법에 비해 더 우수한 검사법인지에 관한 추가 연구가 이루어져야 할 것이다. 마지막으로 자극형 혹은 차단형의 TSH 수용체 항체의 TSH 수용체와의 결합 부위에 있어서도 추가 연구가 필요 할 것으로 생각된다. Autoimmune thyroid diseases share common immunologic evidences including lymphocytic infiltration of the thyroid, circulating thyroid autoantibodies, and T cell immunity. In clinical practice, measurements of thyroid-directed antibodies can be clinically useful in the evaluation of some patients with chronic autoimmune thyroiditis or Graves’ disease. Thyroid peroxidase antibody (TPOAb) is the most sensitive test for detecting autoimmune thyroid disease. The types of methods developed for TSHR Ab measurements are classified relative to their functional activity. TSH binding inhibitory immunoglobulins (TBII) measurement has simplicity, precision, and cost-effectiveness, along with its commercial availability, have made it the most widely used test in clinical laboratories. A recently developed second-generation assay for TBII uses recombinant human TSHR, expressed in eukaryotic cells, this assay showed better diagnostic sensitivity and specificity than the conventional TBII assay. More recently, a human monoclonal antibody to TSHR (M22) with the characteristics of patient thyroidstimulating autoantibodies are developed. Further evaluations are warranted in application of more sensitive and specific assays for measuring TSHR Ab in routine clinical practice.

잔존 갑상선절제술

천용일,신성찬,이병주 대한갑상선학회 2021 International Journal of Thyroidology Vol.14 No.2

Completion thyroidectomy is defined as surgical removal of the remnant thyroid tissue after resection of the thyroidgland. The frequency of completion thyroidectomy varies among researchers, but is estimated to be about 5-45%. Completion thyroidectomy may cause complications due to the presence of inflammation, adhesions, swelling,and scars at the surgical site due to the initial surgery. There is still controversy over the indications and timingof completion thyroidectomy. In this review, we would like to summarize the changes in indications for completionthyroidectomy and review the literature on its necessity.

갑상선 수술의 수술 중 신경모니터링의 적용에 관한 최신지견

유지영 ( Ji Young You ),김훈엽 ( Hoon Yub Kim ) 대한갑상선학회 2021 International Journal of Thyroidology Vol.14 No.1

Intraoperative neuromonitoring is a well-established method used to prevent intraoperative nerve damage, and many studies have been performed in thyroid surgery. We introduced the basic concept and practical application of intraoperative neuromonitoring, as well as its standardized techniques and detailed contents. In addition, the contents of this still yet relatively unknown field, such as its application in transoral robotic thyroidectomy and its application to the external branches of the superior laryngeal nerve, were summarized by referring to many previous studies.

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.

갑상선유두암의 적절한 수술 범위

김완욱 대한갑상선학회 2020 International Journal of Thyroidology Vol.13 No.2

The goal of thyroid cancer surgery is the complete removal of the cancer, verification that patients receiveappropriate treatment through accurate staging after surgery, minimization of local recurrence, and improvementof survival rate. However, maintaining the patient’s functional outcome and quality of life by minimizingpostoperative complications as well as having good oncological outcomes is also important. To determine theoptimal surgical extent, appropriate diagnosis and evaluation should be made on age, gender, tumor size, multiplicity,extrathyroidal extension, lymph node/distant metastasis, and biologic aggressiveness. In the low-risk group, lobectomyis required, and experienced high-volume surgeons may consider ipsilateral prophylactic central lymph nodedissection because of the acceptable risk of hypoparathyroidism. In the intermediate-risk group, personalizeddecision-making should be determined according to the patient’s preferences and characteristics while alsoconsidering the pros and cons of lobectomy or total thyroidectomy. For the patient with high-risk factors, totalthyroidectomy is considered. However, if a total thyroidectomy is not absolutely necessary and complications areexpected, lobectomy could be a second option. If the patient has central lymph node metastasis, a therapeuticcentral lymph node dissection must be performed, and in the case of high-risk groups (T3/4 and N1b), ipsilateralprophylactic node dissection should be considered, and the contralateral parathyroid gland should be preserved. In the high-risk group (especially with massive ipsilateral lymph node metastasis or gross extrathyroidal involvement),the surgeon may consider bilateral central lymph node dissection if the ipsilateral parathyroid gland and therecurrent laryngeal nerve are well preserved, because of the risk of contralateral lymph node metastasis.

미만성 대세포성 B세포 림프종과 MALT 림프종이 혼재된 갑상선 림프종 1예

신향애 ( Hyang Ae Shin ),한재호 ( Jae Ho Han ),이종주 ( Jong Joo Lee ),김철호 ( Chul-ho Kim ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.1

Primary thyroid lymphoma is a rare thyroid tumor, representing approximately 2∼3% of all non-Hodgkin's lymphoma (NHL) and 2∼8% of all thyroid malignancies. Thyroid lymphomas typically occur in middle- to older-aged women. Pathologically, most thyroid lymphomas are non-Hodgkin's lymphomas of B-cell origin whereas Hodgkin's and T-cell thyroid lymphomas occur rarely. Diffuse large B-cell lymphoma (DLBCL) is the most common histologic type followed by mucosa-associated lymphoid tissue (MALT) lymphoma. MALT lymphomas classically arise in a background of longstanding autoimmune thyroiditis. We report a case of mixed diffuse large B-cell lymphoma and MALT lymphoma of the thyroid gland accompanied by Hashimoto's thyroiditis with a review of the literature.

고주파절제를 이용한 자율기능성갑상선결절의 치료

백정환 ( Jung Hwan Baek ),김윤숙 ( Yoon Suk Kim ),이덕기 ( Ducky Lee ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.1

A 45-year-old female patient visited our thyroid center with thyrotoxic symptoms and bulging of left neck. Ultrasonogram showed a 3.1 cm sized solid thyroid nodule. The serum TSH level decreased (0.005 u/ml, normal range; 0.4∼4.0 u/ml), however the serum T3 and FT4 levels were within normal limit. 99mTc pertechnate scintigraphy showed a hot nodule in her left thyroid gland and suppression of the extra-nodular uptake. As she refused surgery and 131I radioiodine therapy, radiofrequency ablation was recommended. After two treatment sessions, the serum TSH level was normalized and hyperthyroid symptoms had resolved. At the 16-month follow-up, the hot nodule was invisible and the suppressed extra-nodular uptake had returned to normal. Radiofrequency ablation is a feasible minimally invasive modality for the treatment of an autonomously functioning thyroid nodule.

한국인 갑상선유두암의 임상적 특징

김광원 ( Kwang-won Kim ) 대한갑상선학회 2010 International Journal of Thyroidology Vol.3 No.2

The prevalence of thyroid nodule has been reported to be from 13 to 67% in the world and from 14 to 41% in Korea. Oh et al. (2010) reported that solid thyroid nodules were found in 39%. The prevalence of thyroid cancer was 2.5% among total subjects, and 6.5% among the subjects with thyroid nodules. The prevalence of papillary thyroid carcinoma (PTC) has increased, but the prevalence of follicular thyroid carcinoma and anaplastic thyroid carcinoma has decreased in Korea between 1980’s and 2000’s. The prevalence of BRAF mutations were reported to be 66∼83% in Korean PTC. The prevalence of ret/PTC rearrangement was 13%, but ras mutations were not detected. Jung et al. (2010) compared the clinicopathologic characteristics of 1,139 papillary thyroid microcarcinoma (PTMC) with those of 1,296 PTC more than 1 cm. Aggressiveness was less frequent in patients with PTMC, but recurrence and mortality rates for PTMC were also significantly lower than those of PTC (p<0.05). The prevalence of PTC variants in Korea was 6.7% and it was much lower than previously reported. The disease-specific survival and recurrence-free survival in classic PTC were not different from those of the favorable variants, but they were higher than those of the aggressive variants (p<0.01).

갑상선유두암에서 전이림프절에 대한 적절한 수술 범위

권현근,이병주 대한갑상선학회 2020 International Journal of Thyroidology Vol.13 No.2

Papillary thyroid cancer (PTC) has a good prognosis, but the frequency of regional lymph node metastasis isreported to be up to 90%. In most patients with PTC, nodal metastasis occurs in a stepwise fashion, withmetastasis beginning in the central cervical compartment, continuing to the ipsilateral cervical compartment. Thereare many controversies about the necessity of prophylactic central neck dissection (CND) and extent of therapeuticCND for lymph node metastasis. Ipsilateral CND with intraoperative frozen biopsy in PTC is a very sensitive anduseful tool for the evaluation of nodal status in the central compartment. The right upper para-esophageal lymphnodes should be removed during dissection in patients with right paratracheal lymph node metastasis. Prophylacticlateral neck dissection (LND) is not recommended, and optimal extent of therapeutic LND is still controversial. Further studies on factors and clinical implications related to suprasternal lymph node metastasis are needed.