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대한갑상선학회> International Journal of Thyroidology

International Journal of Thyroidology update

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수록정보
수록범위 : 1권1호(2008)~11권2호(2018) |수록논문 수 : 293
International Journal of Thyroidology
11권2호(2018년 11월) 수록논문
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KCI등재

1진행성 갑상선암 환자에서 발생하는 Tyrosine Kinase Inhibitor의 이상반응

저자 : 김민주 ( Min Joo Kim ) , 박영주 ( Young Joo Park )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 61-70 (10 pages)

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Tyrosine kinase inhibitors (TKIs) are widely used for the treatment of advanced radioiodine-refractory thyroid cancer. Although the previous studies including large-scale randomized controlled trials have demonstrated the effects of TKIs in advanced thyroid cancers, it has been found that most patients experienced adverse events (AEs). Unlike other cancers, even patients with advanced thyroid cancers are often asymptomatic. Rather, TKI use can make patients suffer adverse events. Therefore, the use of TKI should be decided after the full consideration of AEs as well as its efficacies. While using TKI, AEs should be monitored, evaluated, and managed appropriately, if AEs develop. In this review, the occurrence, evaluation, and management of AEs of sorafenib, lenvatinib, and vandetanib will be described, which TKIs are most commonly used for the treatment of advanced thyroid cancer. Some suggestions for the management of AEs in the real life are also provided.

KCI등재

2방사성요오드 불응성 갑상선암에서 티로신키나아제 억제제 투여로 유발된 출혈 이상 반응 관리

저자 : 신동엽 ( Dong Yeob Shin )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 71-74 (4 pages)

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Adverse events such as hemoptysis and gastrointestinal hemorrhage during tyrosine kinase inhibitor treatment are relatively rare, but the severity of the bleeding can be higher than other common adverse events. It is necessary to educate patients about its possibility so that they can be found early. In this case report of radioiodine refractory thyroid cancer patient, hemoptysis and gastrointestinal bleeding has occurred following lenvatinib administration. Drug interruption and dose modification and dose interruption were required in addition to management for bleeding itself. It is necessary to confirm the high risk of bleeding before the administration of tyrosine kinase inhibitors, and to appropriately control the follow-up interval and drug dosage accordingly.

KCI등재

3방사성요오드 불응성 갑상선암에서 티로신키나아제 억제제 투여로 유발된 중증 피로감의 관리

저자 : 안병철 ( Byeong-cheol Ahn )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 75-77 (3 pages)

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Tyrosine kinase inhibitor is known to prolong progression free survival in radioiodine refractory thyroid cancer patients. Fatigue/asthenia/malaise is one of most common adverse events by the tyrosine kinase inhibitor treatment, and management of the adverse event is important to keep the drug medication longer which is essential for the survival benefit. In the case report, a radioiodine refractory thyroid cancer patient receiving tyrosine kinase inhibitor experienced severe fatigue, and a pathologic fracture of right humerus occurred by slipping down which was tightly linked with the adverse event of the drug. The pathologic fracture was surgically well managed and the adverse event was well controlled by supportive managements combined with dose reduction of the tyrosine kinase inhibitor. The drug administration to the patient was kept more than 1 year without progression of the disease.

KCI등재

4렌바티닙 사용과 관련된 고혈압과 단백뇨의 관리: 증례 보고

저자 : 송의연 ( Eyun Song ) , 김원구 ( Won Gu Kim )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 78-81 (4 pages)

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Lenvatinib, an oral multi-kinase inhibitor, is a valuable treatment option for advanced differentiated thyroid carcinoma. However, severe treatment-related adverse events occur up to 30% of the patients receiving lenvatinib, making it a challenge for clinicians to maintain this drug and therefore affecting the outcome of therapy. Blood vessel related events, such as hypertension or proteinuria, are among the most frequent adverse events. We present a case of 65-year-old man with radioactive iodine refractory papillary thyroid carcinoma with cervical lymph node metastasis and tracheal invasion receiving lenvatinib who developed proteinuria and worsening of hypertension. Management with repeated dose reductions and using supportive medications allowed this patient to continue lenvatinib with his disease stably controlled. Early detection of patients at risk for these adverse events and cautious administration of lenvatinib at appropriate level are crucial in managing patients receiving lenvatinib.

KCI등재

5갑상선암에서 표적치료항암제의 피부 관련 부작용

저자 : 임동준 ( Dong-jun Lim )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 82-87 (6 pages)

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Skin-related toxicity is one of the most important adverse events from multi-target tyrosine kinase inhibitor (MTKI) to treat radioiodine refractory thyroid cancer. As hand foot skin reaction can limit quality of life and therapeutic effectiveness, it is essential to cope with a variety of severity of skin-related toxicity induced by MTKI. Herein, we will discuss two representative cases of skin-related toxicities which were managed by discontinuation/ reduction of therapeutic doses of MTKI and were treated by proper medication in thyroid cancer patients with distant metastasis.

KCI등재

6티로신키나아제 억제제 치료 후 발생한 중증 저칼슘혈증 및 갑상선기능저하증 1례

저자 : 이은경 ( Eun Kyung Lee ) , 이영기 ( Young Ki Lee ) , 황보율 ( Yul Hwangbo ) , 이유진 ( You Jin Lee )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 88-91 (4 pages)

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After introducing tyrosine kinase inhibitors (TKIs) as promising treatments for radioactive iodine refractory advanced thyroid cancer patients, we more often meet patients with TKI-related hormone and electrolyte imbalances in clinics. Hypocalcemia associated with TKI is associated with an imbalance in calcium-vitamin D metabolism. TKI-related hypothyroidism is related to the metabolic rate of thyroid hormones. The two side effects usually occur in the early stages of TKI treatment, and if the imbalance is corrected appropriately, the effects are minor, but in severe cases, the TKI should be discontinued. The authors reported a case of severe hypocalcemia and thyroid dysfunction after TKI treatment. A 56-year-old man suffered from symptomatic hypocalcemia during TKI treatment, which was resolved after he stopped taking the TKI medication. Although calcium and vitamin D replacement have increased, hypocalcemia was recurred and TKI treatments have been permanently stopped due to serious weight loss in grade 3. After the interruption, his calcium levels normalized.

KCI등재

7갑상선ㆍ부갑상선 수술 중 근적외선을 이용한 실시간 부갑상선의 국소화

저자 : 김성원 ( Sung Won Kim ) , 정영욱 ( Yeong Wook Jeong ) , 고윤우 ( Yoon Woo Koh ) , 이강대 ( Kang Dae Lee )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 92-98 (7 pages)

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Intraoperative identification and localization of parathyroid glands are crucial step in preventing postoperative hypocalcemia during thyroid and parathyroid surgery. If there is a method to predict the parathyroid's location rather than detecting and verifying with naked eye, it would make the operator easier to find and identify the parathyroid. Recently, near-infrared light imaging technologies have been introduced in the fields of thyroid and parathyroid surgery to predict the localization of the parathyroid. These are being conducted in two ways: autofluorescence imaging with a unique intrinsic fluorophore in the parathyroid tissues and fluorescence imaging with external fluorescence materials specially absorbed into parathyroid tissues. We are suggest that parathyroid glands can be detected by surgeon with NIR autofluorescence imaging even if they are covered by fibrofatty tissues before they are detected by surgeon's naked eye. These novel techniques are very useful to identify and preserve parathyroid glands during thyroidectomy. In this article, we reviewed the latest papers that describe autofluorescence imaging and exogenous ICG fluorescence imaging of parathyroid glands during thyroid and parathyroid surgery.

KCI등재

8국소 진행된 갑상선암의 수술 - 기관 및 후두, 식도 침범의 치료

저자 : 이국행 ( Guk Haeng Lee ) , 강주용 ( Ju Yong Kang )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 99-108 (10 pages)

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Most thyroid cancers are well-differentiated cancers and have a very good prognosis. About 10% of thyroid cancer, however, invades the surrounding tissues, causing local recurrence and distant metastasis, and eventually affecting survival rate. In locally advanced thyroid cancers, the invasion of trachea, larynx and esophagus, can be occurred by primary tumor and may also result in lymph nodes metastasis. Surgical resection is still mainstay for the treatment of locally advanced thyroid cancer. The main purpose of the surgical resection is to eliminate the cancer completely, therefore, it can cause many complications such as dysfunction of the larynx, trachea and esophagus. It can have a serious effect on the quality of life, therefore there is still controversy on the extent of the surgery. The authors compare and analyze the opinions which were already discussed in the literatures published so far. These will help to select the surgical method.

KCI등재

9갑상선 수술을 위한 새로운 수술 중 신경감시시스템의 개발

저자 : 성의숙 ( Eui Suk Sung ) , 이병주 ( Byung Joo Lee )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 109-116 (8 pages)

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갑상선 수술 후 발생한 성대마비는 삶의 질을 중요시하는 요즘 시대에 제일 치명적 합병증 중 하나이다. 그 결과 수술 중 신경감시시스템의 사용은 보편화되고 있으나 아직 기존의 시스템은 외과 의사가 사용하기에 불편하거나 문제점들이 있다. 그래서 새로운 방식의 신경 탐침과 신경 감시 장치의 개발이 필요한 시점이다. 이에 최근 모든 수술 기구(금속형 기구, 내시경 및 로봇 기구, 에너지 기반 디바이스)에 탈부착이 가능한 신경을 자극하는 신경 탐침 및 후두 떨림을 측정하기 위한 표면압력센서를 이용한 새로운 형태의 수술 중 신경감시시스템의 개발에 대한 연구가 기대된다.


It is very important to identify recurrent laryngeal nerve (RLN) and prevent RLN injury during thyroid surgery. The intraoperative neuromonitoring (IONM) for the prevention of RLN injury is a useful method because it can identify the location and status of RLN and predict postoperative vocal cord function easily. The IONM consists of a stimulating side that applies electrical stimulation to the nerve and a recording side that measures the surface electromyography (EMG) of the vocal cord muscle through electrode endotracheal tube. The nerve stimulator and surgical dissector are separate instruments. So, during IONM for the prevention of the RLN injury in conventional, endoscopic, or robotic thyroid surgery, repeated exchanging between surgical instruments and the nerve stimulator is inconvenient and time consuming. On the recording side, the accuracy of the electrode endotracheal tube which measures the EMG of the vocalis muscle can be affected by contact with between electrode and vocal fold and position change of patient. We would like to introduce recent several researches to overcome the current limitations of IONM.

KCI등재

10갑상선암에서 진행된 림프절 전이에 대한 수술적 치료

저자 : 박민우 ( Min Woo Park ) , 노영수 ( Young Soo Rho )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 11권 2호 발행 연도 : 2018 페이지 : pp. 117-122 (6 pages)

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Metastases to regional cervical lymph nodes occur frequently in patients with thyroid cancer. The appropriate management of regional lymph node is important to achieve good disease control and to classify risk stratification for adjuvant radioactive iodine. However, there are some occasions that neck dissection is difficult and embarrassing in thyroid cancer. Especially, extensive or unusual nodal metastases bring challenges and makes neck dissection more difficult. Carotid artery management is one of the most difficult procedure in neck dissection. The management of patients who have persistent or recurrent cervical metastasis involving the carotid artery has been controversial and treatment dilemma to the surgeon. Metastasis of well differentiated thyroid cancer to the retropharyngeal lymph nodes is rare but occasionally encountered. The complete surgical excision is usually recommended for retropharyngeal lymph node metastasis of well differentiated thyroid cancer. An extensive mediastinal dissection in advanced differentiated thyroid carcinoma is occasionally required. This paper will review recent reports of management of advanced nodal metastasis of thyroid cancer and share the author's personal experience.

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