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대한갑상선학회> International Journal of Thyroidology> Comparison of Thyroid Hormones in Euthyroid Athyreotic Patients Treated with Levothyroxine and Euthyroid Healthy Subjects

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Comparison of Thyroid Hormones in Euthyroid Athyreotic Patients Treated with Levothyroxine and Euthyroid Healthy Subjects

Min Ji Jeon , Suk Hyun Lee , Jong Jin Lee , Min Kyu Han , Hong-kyu Kim , Won Gu Kim , Tae Yong Kim , Won Bae Kim , Young Kee Shong , Jin-sook Ryu
  • : 대한갑상선학회
  • : International Journal of Thyroidology 12권1호
  • : 연속간행물
  • : 2019년 05월
  • : 28-34(7pages)

DOI


목차

Introduction
Materials and Methods
Results
Discussion
References

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Background and Objectives: Levothyroxine (L-T4) monotherapy to normalize TSH level might be not sufficient to restore serum free triiodothyronine (fT3) levels in hypothyroid patients. This study aimed to compare the thyroid hormone levels in euthyroid L-T4 treated athyreotic patients and euthyroid healthy control subjects. Materials and Methods: We included 69 euthyroid L-T4 treated athyreotic female patients after total thyroidectomy and radioactive iodine ablation therapy and 90 euthyroid healthy female. Serum fT3 and free thyroxine (fT4) levels were simultaneously measured using two different assay kits (A and B). Results: The serum fT4 level was higher in the athyreotic patients (kit A: p<0.001, kit B: p=0.046), and the serum fT3 level was higher in control subjects (kit A: p=0.047, kit B: p=0.102). In the control group, the serum fT3 level was stable and not correlated with the TSH level (kit A: tau=-0.10, p=0.18, kit B: tau=-0.06, p=0.40). However, in the patient group, the serum fT3 level was negatively correlated with the TSH level (kit A: tau=-0.22, p=0.012, kit B: tau=-0.31, p<0.001). All thyroid hormone parameters measured by kit A showed higher area under the curve values than those measured by kit B for distinguishing the patients from the control subjects. Conclusion: The serum fT3 levels in L-T4 treated athyreotic euthyroid patients were significantly lower than and varied from those of euthyroid healthy control subjects. Thus, L-T4 monotherapy might not be appropriate for some athyreotic patients to maintain optimal T3 levels.

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  • : 의약학분야  > 내과학
  • : KCI등재
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  • : 반년간
  • : 2384-3799
  • : 2466-1899
  • : 학술지
  • : 연속간행물
  • : 2008-2019
  • : 304


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1한국 임상 현장에서 갑상선의 행동양식 불명 또는 미상의 신생물 이해

저자 : 정찬권 ( Chan Kwon Jung )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 1-8 (8 pages)

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Thyroid tumors include a heterogeneous group of entities with variable clinical behavior and histology, mostly classified as benign or malignant. Neoplasm of uncertain or unknown behavior in thyroid gland was newly adopted by the 2017 edition of World Health Organization (WHO) classification of endocrine organs. The borderline thyroid tumors include a hyalinizing trabecular tumor and three encapsulated follicular-patterned thyroid tumors (follicular tumor of uncertain malignant potential, well-differentiated tumor of uncertain malignant potential, and non-invasive follicular thyroid neoplasm with papillary-like nuclear features). This review summarizes the changes in the 2017 WHO classification of thyroid tumors, highlights their implications for clinical practice in Korea, and briefly discusses National Health Insurance system, cancer insurance policies, and their associated benefits in Korea.

2임상적 치료 결정을 위한 갑상선 미결정 결절의 분자 표지자 검사

저자 : 김형규 ( Hyeung Kyoo Kim ) , 소의영 ( Euy Young Soh )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 9-14 (6 pages)

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Thyroid nodules are the most common endocrine tumor. Ultrasonography and fine-needle aspiration (FNA) are currently accurate diagnostic tools for evaluating thyroid nodules. However, 10-30% of FNA specimens are cytologically indeterminate. Making an accurate diagnosis between benign and malignant nodules is important so that patients with malignant nodule receive proper treatment and patients with benign nodule can avoid unnecessary treatment. Several genetic changes such as point mutations of the BRAF or RAS and rearrangements of the RET/PTC1, RET/PTC3, PAX8/PPARY are used to adjust to indeterminate FNA. Such a mutational analysis has an excellent positive predictive value (PPV), but there is a weakness in the low negative predictive value (NPV). Gene-expression classifier (GEC) has been found helpful in identify nodules that are benign rather than malignant. GEC has an excellent NPV, but there is a weakness of low PPV. Multiplatform mutational and miRNA test (MPT) and next-generation sequencing assay (NGS) are being studied to compensate for these weaknesses. Molecular tests appear to be a good solution for improving the accuracy of indeterminate FNA cytology specimens and support the clinical management decisions in patients with indeterminate cytologic nodules, but further prospective multicenter trials are required for validation of reported findings and need evaluation of cost-effectiveness. This paper will review recently available molecular diagnostic tools of thyroid nodule.

3갑상선 경계성 종양: 외과의사의 관점

저자 : 정기욱 ( Ki-wook Chung ) , 송동은 ( Dong Eun Song )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 15-18 (4 pages)

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Borderline thyroid tumors are composed of hyalinizing trabecular tumor (HTT), well differentiated tumor of uncertain malignant potential (WDT-UMP), follicular tumor of uncertain malignant potential (FT-UMP) and non-invasive follicular tumor with papillary like nuclear feature (NIFTP) by World Health Organization (WHO) definition. They have different pathological feature from each other. However, it is difficult to diagnose with diagnostic imaging, fine needle aspiration (FNA) or core biopsy preoperatively. Thus, the diagnosis is usually made after diagnostic lobectomy. Main surgical concerns about borderline tumor are not performing total thyroidectomy because of relatively indolent nature of these tumors. Unfortunately, some of these tumors can be diagnosed as malignant tumor preoperatively. The other surgical concern is performing completion thyroidectomy or not after diagnostic lobectomy. Decision making is difficult even though it is generally considered that lobectomy alone is enough. In this article, we will discuss clinical features of borderline malignant tumors and surgical strategy for these tumors.

4The Prognostic Value of Central Lymph Node Yield and Ratio in Papillary Thyroid Carcinoma Patients Who Underwent Thyroidectomy with Prophylactic Central Compartment Neck Dissection

저자 : Ohjoon Kwon , Sohee Lee , Ja Seong Bae

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 19-27 (9 pages)

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Background and Objectives: The impacts of prophylactic central compartment neck dissection (pCCND) on the prognosis of papillary thyroid cancer (PTC) are controversial. The aim of this study is to evaluate the relationship between nodal factors of pCCND and the prognosis of PTC patients. Materials and Methods: A total of 1754 patients who underwent thyroidectomy with pCCND were retrospectively reviewed. Nodal factor was defined as the number of metastatic lymph node (MLN), lymph node yield (LNY) and lymph node ratio (LNR). In regarding the cutoff of nodal factors, patients were categorized as low/high MLN, LNR and LNY group. The correlation of clinicopathologic characteristics including nodal factors and recurrence free survival (RFS) were anlalyzed. Results: Of these, 1195 patients underwent thyroidectomy with unilateral pCCND and 559 patients underwent total thyroidectomy with bilateral pCCND. During follow-up, 45 (2.57%) patients showed recurrent disease. Of these, 19 patients underwent bilateral pCCND and 26 cases were unilateral pCCND. Gross extrathyroidal extension (ETE), high MLN and LNR showed statistically significant on RFS in univariate analysis in unilateral pCCND. In multivariate analysis, gross ETE and high LNR were independent risk factor of recurrence in unilateral pCCND. In bilateral pCCND, larger tumor size, minimal ETE, high MLN and LNR were significant correlation with RFS in univariate analysis. However, in multivariate analysis, multiple larger tumor and high LNR showed significant correlation with RFS. LNY was not statistically significant in both unilateral and bilateral pCCND. Conclusion: In regarding nodal factors, high LNR was only independent risk factor to worse RFS in both unilateral and bilateral pCCND in cN0 PTC patients.

5Comparison of Thyroid Hormones in Euthyroid Athyreotic Patients Treated with Levothyroxine and Euthyroid Healthy Subjects

저자 : Min Ji Jeon , Suk Hyun Lee , Jong Jin Lee , Min Kyu Han , Hong-kyu Kim , Won Gu Kim , Tae Yong Kim , Won Bae Kim , Young Kee Shong , Jin-sook Ryu

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 28-34 (7 pages)

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Background and Objectives: Levothyroxine (L-T4) monotherapy to normalize TSH level might be not sufficient to restore serum free triiodothyronine (fT3) levels in hypothyroid patients. This study aimed to compare the thyroid hormone levels in euthyroid L-T4 treated athyreotic patients and euthyroid healthy control subjects. Materials and Methods: We included 69 euthyroid L-T4 treated athyreotic female patients after total thyroidectomy and radioactive iodine ablation therapy and 90 euthyroid healthy female. Serum fT3 and free thyroxine (fT4) levels were simultaneously measured using two different assay kits (A and B). Results: The serum fT4 level was higher in the athyreotic patients (kit A: p<0.001, kit B: p=0.046), and the serum fT3 level was higher in control subjects (kit A: p=0.047, kit B: p=0.102). In the control group, the serum fT3 level was stable and not correlated with the TSH level (kit A: tau=-0.10, p=0.18, kit B: tau=-0.06, p=0.40). However, in the patient group, the serum fT3 level was negatively correlated with the TSH level (kit A: tau=-0.22, p=0.012, kit B: tau=-0.31, p<0.001). All thyroid hormone parameters measured by kit A showed higher area under the curve values than those measured by kit B for distinguishing the patients from the control subjects. Conclusion: The serum fT3 levels in L-T4 treated athyreotic euthyroid patients were significantly lower than and varied from those of euthyroid healthy control subjects. Thus, L-T4 monotherapy might not be appropriate for some athyreotic patients to maintain optimal T3 levels.

6Ultrasonographic Characteristics of the Hyperfunctioning Thyroid Nodule and Predictive Factors for Thyroid Stimulating Hormone Suppression

저자 : Won Sang Yoo , Hoon Sung Choi

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 35-43 (9 pages)

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Background and Objectives: Thyroid scan is a good tool for diagnosis of hyperfunctioning thyroid nodules (HNs), however it has been limited in use in a primary clinical practice, because of its inconvenience and low accessibility. This study aimed to analyze ultrasonographic (US) characteristics of HNs and to predict HNs by US. Materials and Methods: We included 114 patients who exhibited results of 'hot' nodule in the thyroid scan from 2008 to 2017. Analysis for US characteristics included 73 patients without unclear US images and other inevitable reasons. We compared US characteristics of HNs with cold nodules that showed “cold” in the thyroid scan. Additionally, we compared US characteristics of HNs between suppressed thyroid-stimulating hormone (TSH) (<0.25 uIU/mL) or normal TSH, and analysis receiver operating characteristics (ROC) curve for prediction of suppressed TSH among HNs. Results: The HNs showed more partially cystic nodule, isoechoic echogenicity, hypervascularity and presence of halo in the US finding than the cold nodule. In subgroup analysis of nodules with TSH suppression among HNs, the TSH suppression nodules was lager in max size and volume than the normal TSH nodules. In ROC analyses for prediction of the TSH suppression among HNs, area under receiver operating characteristics curves was 0.736 in max size, 0.761 in volume. Conclusion: HNs showed more frequently partially cystic contents, isoechoic echogenicity, hypervascularity, and peripheral halo sign in US finding. Thyroid nodule size and volume were associated with suppressed TSH level of HNs, and optimal cutoff levels for prediction of TSH suppression among HNs were 2.6 cm and 1.13 ㎤, respectively.

7High Body Mass Index and Thyroid Stimulating Hormone Levels Do Not Affect Thyroid Nodule Selection for Fine-Needle Aspiration Biopsy after Ultrasound Evaluation

저자 : Hyun Gi Kim , Hye Sun Lee , Eun Kyung Kim , Chung-mo Nam , Hee Jung Moon , Hae Kyoung Jung , Jin Young Kwak

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 44-53 (10 pages)

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Background and Objectives: This study was to evaluate whether high body mass index (BMI) or thyroid stimulating hormone (TSH) level would affect selecting thyroid nodule for fine-needle aspiration biopsy (FNA) after ultrasound (US) evaluation. Materials and Methods: A total of 3155 thyroid nodules (2159 benign and 996 malignant nodules) were included. Four grades of BMI and three levels of TSH were applied for grouping. US features of the thyroid nodules were divided into 'probably benign' and 'suspicious for malignancy' categories. Patients were grouped according to gender and univariate and multivariate logistic regression analysis were used to find the association between variables and malignancy. Results: TSH levels were significantly higher in the malignant group (p<0.001). The grades of BMI did not show difference between the malignant and benign groups (females, p=0.074 and males, p=0.157). Younger age and 'suspicious for malignancy' US category were independent risk factors for malignancy in both genders. In females, a high TSH level (odds ratio=1.010, p<0.001) had significant association with malignancy. Except for younger age (odds ratio=0.998, p<0.001), no variable in nodules with 'probably benign' US category was significantly associated with malignancy. Conclusion: High TSH levels were more frequent in thyroid malignancy group, but neither high BMI nor high TSH level give additional information for FNA selection after US.

8이차성 부갑상선기능항진증에서 부갑상선전절제술 및 자가 이식술 1례

저자 : 김성훈 ( Sung Hoon Kim ) , 서다혜 ( Da Hea Seo ) , 황선덕 ( Seun Deuk Hwang ) , 김지원 ( Ji Won Kim )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 54-57 (4 pages)

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Secondary hyperparathyroidism (HPT) usually result from parathyroid gland hyperplasia that produces excess parathyroid hormone (PTH). Decreased renal function leads to elevate serum phosphate levels and reduce vitamin D production, which results in hypocalcemia. Skeletal resistance to PTH results in persistently and frequently extremely elevated PTH levels and renal osteopathy. Treatment of choice for secondary HPT is medical management including calcitriol and vitamin D. However, for some cases in calciphylaxis and the failure including PTH >800 pg/mL or osteoporosis under maximal medical management surgical intervention could be an alternative option. We described a case of 47-year-old woman with surgical intervention for secondary hyperparathyroidism.

9Concurrent Medullary Thyroid Carcinoma and Primary Thyroid Lymphoma (Diffuse Large B Cell Lymphoma): the First Case Report

저자 : Yeeun Han , Yon Hee Kim , Hye Jeong Kim , In Ho Choi

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 58-63 (6 pages)

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Cases of simultaneously occurring medullary thyroid carcinoma (MTC) and lymphoma are extremely rare. An 84-year-old woman visited the hospital due to dyspnea, resulting from rapidly aggravated enlarged neck mass. Ultrasonography revealed two lesions in the thyroid and they were diagnosed as concurrent medullary thyroid carcinoma and diffuse large B cell lymphoma after total thyroidectomy. A few cases simultaneously diagnosed with MTC and systemic lymphoma have been reported. However, the coexistence of MTC and primary thyroid lymphoma is extremely rare.

10갑상선에 전이된 경부 식도의 편평세포암종 1례

저자 : 강주용 ( Ju Yong Kang ) , 김정준 ( Jung Jun Kim ) , 최익준 ( Ik Joon Choi )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 12권 1호 발행 연도 : 2019 페이지 : pp. 64-69 (6 pages)

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Despite thyroid is a highly vascularized organ, clinically significant metastatic spread to the thyroid is considered uncommon. There is a reported incidence of up to 24.0% metastases to the thyroid in autopsy series. The most frequently noted primary sites are the kidney, breast, and lung. The metastatic spread of alimentary tract is quite rare, and the majority comes from the colo-rectum. We present a case of squamous cell carcinoma of the cervical esophagus presenting as thyroid nodule in an apparently healthy 54 year-old male patient. This might be the first case of esophageal carcinoma metastases to the thyroid presenting in South Korea.

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