• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.4
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• pp.442-446
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• 1995

Thyroid carcinomas are usually classified as papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma and anaplastic thyroid carcinoma. Among the thyroid carcinomas, the incidence of medullary and anaplastic thyroid carcinoma is low, but the rate of lymph node & distant metastasis from them are more common compared to other types. Follicular thyroid carcinoma has a low rate of lymph node metastasis as 10% and has a high occurrence of hematogenous metastasis to lung, bone, brain and liver. Papillary thyroid carcinoma accounts for $60{\sim}70%$ of whole thyroid carcinomas and the cervical lymph node metastasis is $21{\sim}81%$ including micrometastasis, but the distant metastasis is rare. In the case of bone metastasis, follicular type reveals most frequent, and the rate is about 5%, and more likely to be found on vertebra, pelvis, ribs, femur, and skull. The clinical symptoms of bone metastasis are pain, swelling, pathological fracture and radiologically osteolytic lesions can be observed. But distant metastasis of papillary thyroid carcinoma is very rare and especially, bone metastasis has hardly been reported. The treatment modalities of metastatic thyroid carcinoma to mandible are known as follows : thyroidectomy to treat primary site, resection of the affected site of mandible, external beam radiotherapy and radioiodine therapy etc.

• Journal of Genetic Medicine
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• v.6 no.1
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• pp.91-94
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• 2009

Werner syndrome (WRN), or adult progeria, is a very rare, autosomal recessive disorder characterized by the appearance of accelerated aging, including cataracts, gray hair, skin atrophy, and atherosclerosis. This syndrome is caused by mutations in the WRN gene and had a high risk of a spectrum of rare neoplasms including: i) non-epithelial malignant or pre-malignant tumors/conditions, osteosarcomas and soft tissue sarcomas, malignant melanomas, myeloid leukemia and myelodysplastic syndrome; ii) an epithelial neoplasm, thyroid carcinoma, and iii) meningiomas. Recently, authors experienced a case of Werner syndrome complicated by bone metastasis of rhabdomyosarcoma in a 20-year old Korean man. The patient revealed a painful mass on his right knee and progeroid features, short stature, scalp alopecia, abnormal dentition, craniofacial disproportion, hypothyroidsm, cataracts and osteoporosis. The onset of symptoms of Werner syndrome generally precedes any later symptoms of associated conditions, such as malignant tumor. Therefore, early recognition of Werner syndrome is important to assist identification of malignant tumors at an early stage in this patient group.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.183-191
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• 2006

Thyroid nodules are less common in children than in adults and their management is still controversial. The clinical presentations, operations, complications, histopathologic findings, and postoperative progressions of 34 pediatric patients that underwent thyroidectomy for palpable thyroid nodule at the Department of Surgery, Seoul National University Children Hospital between 1986 and 2003 were studied retrospectively by reviewing medical records and telephone interviews. The mean age of the patients was 11.8 years old. There were 23 females (67.6 %) and 11 males (32.4 %). Surgical indications were clinical need of histological confirmation (n=15), unresponsiveness to thyroxin replacement therapy (n=10), suggestion of the carcinoma on fine needle aspiration cytology (n=5), cosmetic purpose-a huge benign nodule (n=2), completion thyroidectomy for medullary thyroid carcinoma (n=1), and prophylactic thyroidectomy in a MENIIpatient (n=1). Unilateral Lobectomy was performed in 20 patients (57.1 %), subtotal thyroidectomy in 8 (22.9 %), total thyroidectomy in 5 (14.7 %), and completion thyroidectomy in 1 (2.9 %). Lymph node dissection was performed in 9 cases. Benign tumor was found in 23 patients (67.6 %), adenomatous goiter (n=18) and follicular adenoma (n=5). Malignant tumor was found in 11 children (32.4 %), 9 papillary carcinomas (26.5 %), and 2 medullary carcinomas (5.9 %). Of the 9 papillary carcinomas, 7 cases (77.8 %) had lymph node metastasis. No lymph node metastasis was found in 2 medullary carcinomas. Complications developed in 5 cases - transient hypocalcaemia (n=2), and temporary hoarseness (n=3). There was no mortality. Median follow-up period was 7.4 years (0.5-18 years). One patient showed recurrence in cervical lymph nodes 10 years after surgery and modified radical neck dissection was performed. Because of the high incidence of malignancy and advanced stage at initial presentation, more meticulous diagnostic work up is necessary for children with thyroid nodule, and more radical surgical treatment should be performed when malignant nodule is suggested.

• Advances in pediatric surgery
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• v.6 no.2
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• pp.95-99
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• 2000

Thyroid carcinoma is relatively rare in children. Eight cases of thyroid carcinoma were among 18 patients operated upon for thyroid tumors at Pediatric Surgery, Asan Medical Center in 11 years' period between 1989 and 2000. Five patients were boys and three were girls. The age distribution ranged from 10 to 14 years with a median age of 11.6 years. We studied clinical presentations, diagnostic workup, pathology, treatment, and follow-up (recurrence, mortality, and survival). All patients presented with anterior neck mass but one with multiple cervical lymph nodes enlargement. Familial history of thyroid cancer was seen in one case. All patients had a cold nodule by 1-131 thyroid scan. Fine needle aspiration (FNA) biopsy was performed in all patients. The right lobe was involved in four patients and the left lobe in two. Two had both lobes involvement. Pathologically, six cases were papillary carcinoma, one was follicular carcinoma, and one insular carcinoma. Four patients underwent unilateral lobectomy and isthmectomy. Total thyroidectomy was performed in three patients. The insular carcinoma case was preoperatively diagnosed as follicular neoplasm by FNA. After confirmation of the pathology by initial right thyroid lobectomy, total thyroidectomy was subsequently done. Cervical lymph node metastases were presented in three cases (37.5%), and lung metastasis in two cases (25%). Three patients received postoperative I-131 ablation. After a median follow-up of 53 months, all patients were alive without evidence of recurrence. In conclusion, thyroid carcinoma in children is frequently associated with lymph nodes involvement and distant metastasis, however, the prognosis is relatively good.

• Journal of Sasang Constitutional Medicine
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• v.28 no.2
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• pp.132-146
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• 2016

Objectives This study's object was to observe the comparative effects of Yangkyuksanhwa-tang, Palmulgunja-tang and Cheongpyesagan-tang on the chronic LT4(levothyroxine) induced hyperthyroidism in rats.Methods Six groups, each of 8 rats in group, were used in this study. Saline and distilled water treated rats are intact control group. Hyperthyroidism was induced by daily subcutaneous LT4 300 μg/kg treatment for 27 days(LT4 control). Since 12th LT4 treatment PTU(propylthiouracil) 10 mg/kg was intraperitoneal injected(PTU group) and aqueous extracts of Yangkyuksanhwa-tang, Palmulgunja-tang and Cheongpyesagan-tang(YS, PG and CS) 500 mg/kg were orally administrated(YS, PG, CS group), once a day for 15 days. The differences in the body, thyroid gland and epididymal fat pad weights, serum T3(tri-iodothyronine), T4(thyroxine), TSH(thyroid-stimulating hormone), thyroid gland and epididymal fat pad histopathology, liver weight, AST(asparte aminotransferase), ALT(alanine aminotransferase) concentrations, hepatic lipid peroxidation, GSH(glutathione), SOD(superoxide dismutase), CAT(catalase) activities, liver histopathology were observed to evaluate effects on hyperthyroidism, liver damages and antioxidant effects.Results As results of LT4 treatment, hyperthyroidism and related liver damages such as lower body, thyroid weights, higher serum T3, T4, AST, ALT levels, thinner follicular lining epithelium in thyroid glands were observed. However, these symptoms were inhibited by oral treatment of YS, PG and CS. As compared with PTU treatment, these herbal prescriptions showed lower overall efficacy on the hyperthyroidism, but YS showed more favorable effects on the hepatic antioxidant defense systems.Conclusions This results suggest that YS, PG and CS favorably control the LT4 induced hyperthyroidism and related liver damages in rats through modulation of the hepatic antioxidative defense systems.

• Laboratory Medicine Online
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• v.7 no.2
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• pp.83-87
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• 2017

Pseudohypoparathyroidism (PHP) is a rare disorder caused by genetic and epigenetic aberrations in the GNAS complex locus resulting in impaired expression of stimulatory G protein ($Gs{\alpha}$). PHP type Ib (PHP-Ib) is characterized by hypocalcemia and hyperphosphatemia due to renal resistance to the parathyroid hormone, and is distinguished from PHP-Ia by the absence of osteodystrophic features. An 11-yr-old boy presented with poor oral intake and cramping lower limb pain after physical activity. Laboratory studies revealed hypocalcemia, hyperphosphatemia, and increased parathyroid hormone levels. The GNAS complex locus was evaluated using the methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) assay. Gain of methylation in the NESP55 domain and loss of methylation in the antisense (AS) transcript, XL, and A/B domains in the maternal allele were observed. Consequently, we present a case of PHP-Ib diagnosed using MS-MLPA.

• Journal of Endocrine Surgery
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• v.18 no.4
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• pp.219-227
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• 2018

Purpose: The primary objective of the present study was to investigate the course of anxiety and depression in thyroidectomy. The second objective was to investigate the association between somatic symptoms and psychological symptoms, and the final objective was to identify the sociodemographic, clinical, and psychosocial factors that affect psychiatric morbidity. Methods: This prospective study, 101 patients who were admitted to the Endocrine Surgery Clinic of the Department of General Surgery, Istanbul Faculty of Medicine, University of Istanbul, with thyroid pathology were included in the study. Data were collected before surgery, and in the early, and late periods after surgery. Data were collected using a semi-structured interview form, a visual analogue scale, and the Hospital Anxiety and Depression Scale. Results: The average scores of anxiety and depression before surgery were statistically significantly higher compared with the early and late periods after surgery (P<0.001). Psychological morbidity was identified about 10% of patients before surgery and remained after thyroidectomy. A poor positive correlation founded between somatic symptoms and psychological condition in period surgery (P<0.05). Various sociodemographic features and psychosocial parameters affected anxiety and depression level (P<0.05). Conclusion: Anxiety and depression level in thyroid diseases decreased after thyroidectomy. These patients may express psychologic distress through somatic symptoms. Screening of psychological morbidity is suggested in patients planned thyroid surgery, especially in women, low-educated, inadequate social support, attributed to psychological causes.

• Journal of Endocrine Surgery
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• v.18 no.4
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• pp.228-235
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• 2018

Purpose: The epidermal growth factor receptor (EGFR) family plays a crucial role in the growth of malignant tumors. EGFR and human EGFR 2 (HER2) protein overexpression are associated with an unfavorable prognosis and are important therapeutic targets in breast cancer. The aim of this study was to evaluate the relationship between EGFR and HER2 expression and clinicopathological factors in papillary thyroid carcinoma (PTC) at a single institution. Methods: A total of 129 consecutive patients with PTC were enrolled in this study and underwent thyroid surgery between October 2013 and February 2015. EGFR and HER2 protein expression was evaluated in the 129 primary tumors by immunohistochemistry, and the results were compared with the clinicopathological features. Results: Of the 129 PTC tumors, 20 (15.5%) were HER2 positive, and 109 (84.5%) were HER2 negative. Moreover, EGFR positivity were observed in 111 (86%) tumors. The mean age of the patients was $46.3{\pm}11.9years$ (range, 20-74 years), and the mean tumor size was $1.08{\pm}0.75cm$ (range, 0.2-3.5 cm). Tumor size, extrathyroidal extension, histological subtype, and TNM stage were not significantly associated with EGFR or HER2 expression. Meanwhile, high Ki-67 labeling index was significantly associated with EGFR expression (P=0.002), HER2 expression was significantly associated with younger age (${\leq}45years$) and cervical lymph node metastasis. Conclusion: Based on our data, it is not clear whether EGFR and HER2 expression is associated with tumor aggressiveness in PTC.

• Journal of Korean Medicine for Obesity Research
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• v.23 no.2
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• pp.78-85
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• 2023

Objectives: Weight gain is one of the symptoms of hypothyroidism and it could deteriorate thyroid function. Our objectives are to evaluate weight changes and analyze adverse events in overweight and obese women with hypothyroidism who were prescribed Gamitaeeumjowee-tang. Methods: A retrospective chart review was conducted using medical records of patients with hypothyroidism, who had body mass indexes (BMI) above 23 and were prescribed Gamitaeeumjowee-tang for 12 weeks between August 2017 and November 2022. Reported adverse events (AEs) were assessed by severity, causality and system-organ classes. Results: Thirty patients were included (mean±standard deviation, age 46.10±9.94 years, weight 70.52±11.18 kg, BMI 28.30±3.80 kg/m²). The mean total weight loss of hypothyroidism patients was 5.45±2.77 kg, while the mean weight loss rate and mean BMI change were 7.66±3.41% and 2.18±1.07 kg/m², respectively. Among evaluated causality of adverse events, 'Unlikely' was predominant (80.8%) and severity assessment showed most of the symptoms were mild (91.7%). Conclusions: Gamitaeeumjowee-tang could be an option for hypothyroidism patients, who are overweight or obese, to lose weight and no serious adverse events occurred. Further well-designed clinical studies are recommended.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1981.05a
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• pp.10-10
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• 1981

The thyroglossal duct cyst is relatively rare disease that derived congenitally from the remnant of thyroglossal duct and that was found anywhere from the foramen cecum to pyramidal lobe of thyroid. We studied the 62 cases of above disease who admitted and operated at E.N.T. dept. of N.M.C. for 20 years since 1961 to 1980 on the clinical and histopathological aspect, and we concluded following results. 1. In the age distribution, 45 cases(72.6%) were under 20 years, and in the age distribution of the known on-set of symptoms, 26 cases(58.0%) were under 10 years. In the duration, 23 cases(37.0%) were under 1 year. The sex ratio of male to female revealed 1.2:1. 2. The palpable mass were complained at 48 cases(77.4%) and 14 cases(22.6%) complained of the discharge from sinus tracts and the other complaints were dysphagia and odynophagia, etc. 3. In location 55 cases (88.7%) were at midline, 1 case(1.6%) was at right and 6 cases(9.7%) were left sided. And 47 cases(75.8%) were situated at infrahyoid region, 11 cases(17.7%) at suprahyoid, 3 cases(4.8%) at suprasternal, only 1 case(1.6%) at intralingual region. 4. In 27 cases formed fistulae, spontaneous occurrance were 7 cases and artificial occurrance were 20 cases. 5. In histopathologically among 41 cases preserving available slides, 5 cases(12.2%) had single duct and 20 cases(48.8%) had multiple accessory ducts, but 16 cases were impossible to detect the ducts. The lining epithelium composed of chiefly respiratory and squamous epithelium. 15 cases had inflammatory reaction at periductal area and 7 cases had around the cysts. The ectopic thyroid tissue was found on 6 cases(14.6%) and 1 case had the follicular adenoma. 6. In the recurrance rate among 43 cases performed sistrunk type operation, 2 cases (4.6%) recurred, and among 19 cases performed simple removal of cysts, 4 cases (21.1%) recurred.