• Title/Summary/Keyword: Graves' Disease

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Reevaluation of the Thyroid Scan for the Assessment of Pathophysaologic Status of Thyroid Disease (갑상선 질환의 병태생리를 이해하는 데 있어서 갑상선 스캔의 재평가)

  • Woo, In-Sook;Nah, Jung-Il;Kim, Deog-Yoon;Koh, Eun-Mi;Kim, Sung-Woon;Yang, In-Myung;Kim, Jin-Woo;Kim, Young-Seol;Kim, Kwang-Won;Choi, Young-Kil
    • The Korean Journal of Nuclear Medicine
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    • v.25 no.1
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    • pp.101-109
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    • 1991
  • To diagnosis and understand the pathophysiologic status of thyroid disease, not only hormonal measurments but also thyroid scan is believed to have a unique role. Especially in the cases of the change of the thyroid function by thyroiditis, it is emphasized that thyroid scan can be helpful in differential diagnosis. Discordant results of thyroid hormone levels and thyroid scan are found in transient hyperthyroidism, or in transient hypothyroidism. We analysed and reevaluated thyroid scan to look at the importance of thyroid scan. The results are summerised as folows: 1) 80% of hyperthyroid patients had hyperthyroidism increased RAIU with even density. they are compatible with Graves' disease. 2) 2.1% of hyperthyroid patients had normal or decreased RAIU, which are classfied as high iodine turn over genuine hyperthyroidism. 3) 8.5% of hyperthyroid patients had markedly decreased RAIU at both 2 hour and 24 hour, whose patholgic processes are suggested to be heterogenous namely subacute thyroiditis, postpartum thyroiditis, Hashimoto's thyroiditis, and painless thyroiditis. 4) 45% of hypothyroid patients had increased 24hr RAIU, 30% of hypothyroid patients were normal, 25%, decreased. In conclusion, thyroid scan should be reevaluated its useful role to asses the pathophysiologic status of thyroid disease. Especially in cases of transient thyrotoxicosis, thyroid scan is essential to diagnose and follow up the disease process.

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Thyroid Tumors in Children - Review of Surgically Treated Cases - (소아에서의 갑상선 종양 - 수술적 체험 예들의 임상 고찰 -)

  • Yang Sung-Hwan;Kim Gab-Tae;Oh Sung-Su;Chung Eul-Sam
    • Korean Journal of Head & Neck Oncology
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    • v.14 no.1
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    • pp.54-60
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    • 1998
  • Objectives: We'd like to give help in diagnosis and treatment of children's thyoid tumor through our clinical experiences and reference consideration. Materials and Methods: The authors report their experiences with 33 cases of thyroid tumor in patients younger than 16 years of age who were treated at Presbyterian Medical Center from 1979 to 1995. Results: 1) Girls were more predominant than boys by a ratio of 5.6:1. The peak incidence was in the 15 years old of age. 2) The final diagnosis in the 33 patients were thyroid carcinoma in 12 cases, nodular goiter in 6 cases, adenoma in 6 cases, Graves disease in 4 cases, Hasimoto's disease in 4 cases and cyst in 1 case. 3) All of 12 patients with thyroid cancer had nodular tumor. 4) In 5 of 6 patients with palpable cervical lymphadenopathy, the final diagnosis was thyroid carcinoma. 5) Delayed diagnosis arose in 6 of 12 thyroid carcinomas which were treated for long periods as benign disease. 6) The surgical procedures were total thyroidectomy in 3 cases, subtotal thyroidectomy in 13 cases and thyroid lobectomy in 17 cases. 7) 11 of 12 patients with thyroid carcinoma had subtotal or total thyroidectomy with lymphnode dissection and only one had lobectomy. 8) The overall rate of postoperative complication was 3%(1 of 33 patient). 9) Postoperative $^{131}I$ therapy was done in 7 case because of recurrence and distant metastasis in six and severe local invasion in one. 10) In thyroid cancer, the metastatic rate of lymph node at initial surgery was 81%(9/11) and rate of recurrence was 50%(6/12). 11) Patients with thyroid carcinoma were followed up for a mean of 12 years but only one died as a result of thyroid carcinoma 3.5 years later. Conclusion: The authors suggest that thyroid tumors in childhood should receive the benifit of joint management by endocrine pediatrician and experianced surgeons with an agreed protocol of diagnosis and management. We, also, recommend aggressive surgical and $^{131}I$ treatment as the most effective regimen for children with thyroid carcinoma.

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Thyrocyte HLA-DR Expression in Variety of Thyroid Diseases (갑상선 질환들에서 여포세포의 HLA-DR발현)

  • Chang Eun-Sook;Sohn Soo-Sang;Cho Seung-Che;Kim In-Ho;Kim Sang-Pyo;Kang Joong-Shin
    • Korean Journal of Head & Neck Oncology
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    • v.13 no.1
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    • pp.16-23
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    • 1997
  • Although normal thyroid epithelial cells do not constitutively express HLA-DR antigen, their expression in wide spread within thyroid glands obtained from the human with autoimmune thyroid disease and with many neoplastic thyroids. We have, therefore, studied immunohistochemically with regard to the expression of HLA-DR antigen of thyroidectomy specimens from 50 patients of various thyroid diseases with use of paraffin-embedded tissue. One or two sections from each case were stained with commercially available mouse monoclonal antibody for class II HLA-DR antigen(HLA-DR/Alpha, DAKO) and examined by semiquantitative counting system for thyrocytes, neoplastic thyrocytes and other cells expressing HLA-DR antigen. All patients with lymphocytic thyroiditis(2/2) and diffuse hyperplasia(Graves' disease)(5/5), most patients with Hashimoto's disease(9/ll) expressed HLA-DR antigens in thyrocyte with abundant HLA-DR expressing lymphocytic infiltrates with lymph follicle formation in its vicinity or adjacent to the lesion. Most patients with papillary carcinoma(9/1l) had HLA-DR antigen detected in malignant thyrocytes ; while follicular carcinoma(0/3) and follicular adenoma(0/5) did not have detactable HLA-DR immunoreactivity. Adenomatous goiter(3/7) had HLA-DR antigen detected focally in lesser than half cases. Conversely, in four papillary carcinomas and three adenomatous goiters, HLA-DR expression of thyrocytes was found in the absence of HLA-DR expressing lymphoid infiltrates. In such cases therefore other factors more than thyroid autoimmunity must be causative for HLA-DR immunoreactivity. The results of this study indicate as follows. 1) The expression of HLA-DR on thyrocytes involved in autoimmune reactions appeared to be secondary to cytokine release from associated lymphocytic infiltrates. 2) Thyrocytes in thyroid lesions with equal degrees of lymphocytic infiltration without HLA­DR expression exhibited no HLA-DR immunoreactivity. 3) In neoplastic thyrocytes, most papillary carcinoma(9/11) exhibited detactable HLA-DR expression, while follicular carcinoma/adenoma(0/3/0/5) exhibited no detactable HLA-DR immunoreactivity which suggest the existence of divergent mechanisms inducing and modulating HLA-DR expression of different types of neoplastic thyrocytes.

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Thyroid and Parathyroid Surgery without Wound Drains (갑상선 및 부갑상선 수술시 배액관 삽입술에 대한 검토)

  • Chung Woung-Youn;Park Cheong-Soo
    • Korean Journal of Head & Neck Oncology
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    • v.11 no.2
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    • pp.119-124
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    • 1995
  • Traditionally, wound drainage after thyroid or parathyroid surgery has been widely used to prevent airway obstruction due to accumulation of hematoma or seroma within the paratracheal dead space. Recently, however, the routine use of drains after thyroid or parathyroid surgery has become a matter of controversy. To determine whether the rouine use of drains after thyroid or parathyroid surgery is warranted, a prospective study on the complications after various types of thyroid or parathyroid surgery without wound drains was conducted. Three hunded sixty-six consecutive patients underwent thyroid or parathyorid surgeries by one surgeon from January through December 1994 were included in this study. Of these, only 38 patients (10.4%) required the wound drains. Indications for drainage included the patients with a large dead space(n=9) or wet operative field at the conclusion of surgery(n=11), and patients with radical neck disection(n=18). In the remaining 328 patients(89.6%), the wounds were closed without drains after thyroid lobectomy and isthmusectomy(n=226), bilateral subtotal thyroidectomy(n=21), total or near-total thyroidectomy(n=62), isthmusectomy(n=9) and parathyroid surgery(n=l0). Histologic findings revealed benign tumors in 214(65.2%), carcinoma in 89(27.1%), Graves' disease in 15(4.7%), hyperparathyroidism in 7(2.1%) and parathyroid cyst in 3(0.9%). Among the 328 patients without drain used, wound related complications were seen in only 15 patients(4.6%); 12 patients with seroma and 3 patients with hematoma. All but one complications could be controlled by two or three aspirations, and the remaining one patient required re-exploration. There were no instances of laryngeal nerve palsy or wound infection. The mean length of hospital stay after surgery was 2.8 days with a range of 1 to 11 days. These results support the routine use of drains is not warranted in most thyroid or parathyroid surgeries.

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A Review of Randomized Controlled Trials of Herbal Medicine Treatment for Hyperthyroidism (갑상선기능항진증의 한약 치료에 대한 무작위 대조군 연구의 문헌 고찰)

  • Lee, Hee-Yoon;Hwang, Su-In;Park, Jang-Kyung;Yoon, Young-Jin
    • The Journal of Korean Obstetrics and Gynecology
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    • v.34 no.3
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    • pp.114-136
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    • 2021
  • Objectives: The purpose of this study is to analyze the effectiveness and safety of herbal medicine treatment for treating hyperthyroidism. Methods: We searched for randomized controlled trials of Hyperthyroidism treated with herbal medicine, published from January 2016 to May 2021, through electronic database such as Pubmed, EMBASE, China Academic Journal (CAJ). Interventions and results of the selected clinical studies were analyzed. Results: The 25 randomized controlled trials were finally included according to the inclusion and exclusion criteria. Treatment group was treated with herbal medicine alone in 2 studies, and with herbal medicine and conventional medicine in 23 studies. Control group was treated with conventional medicine. Outcome measures are total efficacy rate, thyroid function test, Traditional Chinese medicine (TCM) syndrome scores, liver function test, recurrence rate, etc. Prunellae Spica (夏枯草) (60%) was the most frequently used herb in herbal medicine treatment. In all of 25 studies, treatment group was more effective and safer for hyperthyroidism than the control group. Conclusions: This study indicates that herbal medicine treatment alone or combined with conventional medicine treatment could be helpful in improving the therapeutic effect on hyperthyroidism and reducing side effects as well.

A Case Report on The Relieving Effect of Herbal Medicine on Clinical Symptoms in Patients with Hyperthyroidism Taking Methimazole (메티마졸 투여 중인 갑상선기능항진증 환자에서 한약의 임상증상 완화효과에 대한 증례보고)

  • Henja Yun
    • Herbal Formula Science
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    • v.31 no.3
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    • pp.203-213
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    • 2023
  • Objectives : The purpose of this study is to report the symptomatic relief effect of a herbal prescription combined with methimazole for hyperthyroidism caused by Graves' disease. Methods : After diagnosis of hyperthyroidism, methimazole was initially administered alone. As the clinical symptoms continued, a herbal medicine combining Gamiondam-tang and Cheongsimyeonja-eum was administered together with methimazole. Blood concentrations of hormones were measured, and the degree of clinical symptoms was measured using the NRS scale. The effect of herbal medicine on heat intolerance was analyzed by Wilcoxon rank sum test, and the relationship between thyroid hormone and heat intolerance was analyzed by Pearson's correlation coefficient. Results : Heat intolerance symptoms were significantly reduced when the herbal prescription was administered in parallel than when methimazole was administered alone (w=296, p=0.001). The decrease in heat intolerance was not related to thyroid hormone levels (p=0.27, 0.37). Conclusions : It was found that the herbal medicine combining Gamiondam-tang and Cheongsimyeonja-eum was effective in treating hyperthyroidism symptoms including heat intolerance.

Identification of Three Fungi Associated with Stem and Twig Diseases of Juglans sinensis in Korea and Characterization of Factors Affecting Their Growth (호도나무 줄기와 가지의 병원균(病原菌) 삼종(三種)의 동정(同定)과 균사생장(菌絲生長)에 영향(影響)을 미치는 요인(要因) 구명(究明))

  • Lee, Myeong Ok;Lee, Young Hee;Cho, Won Dae;Lee, Kyung Joon
    • Journal of Korean Society of Forest Science
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    • v.81 no.2
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    • pp.191-199
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    • 1992
  • This study was conducted to identify fungi causing canker dieback and melanconis disease of walnut trees (Juglans sinensis Dode) in Korea and clarify the pathogenicity and factors affecting the growth of these fungi. The causal fungi isolated from infected walnut stems and branches obtained from the commercial walnut orchards in Cheonwon, Goesan, Youngdong were identified as Botryosphaeria dothidea (Moug, ex Fries) Casati et de Notaris, Phoniopsis albobestita Fairman, Melanconis juglandis (Ellis et Everhart) Graves and their pathogenicity was confirmed by inoculation test. Temperature range for minimum growth of three fungi was 8 to $35^{\circ}C$ and the optimum temperature for mycelial growth of B. dothidea and P. albobestita ranged from 25 to $30^{\circ}C$, while the optimum temperature for M. juglandis ranged from 20 to $25^{\circ}C$. The optimum pH range for mycelial growth of P. albobestita was 4.0~5.0 and that for B. dothidea and P. juglandis 4.0~8.0. Glucose, sucrose, starch or maltose, as a carbon source, and histidine or potassium nitrate as a nitrogen source were more suitable compounds for growth. of B, dothidea, P. albobestita grew very well on the medium containing alanine and potassium nitrate as a nitrogen source, and utilized well glucose and sucrose as a carbon source. M. juglandis grew well on the medium containing glucose, and sucrose as a carbon source and utilized well potassium nitrate as a nitrogen source. The dieback and twig blight caused by P. albobestita were more severe than those by B. dothidea and M. juglandis at three locations investigated. Incidences of canker and dieback were more frequently observed in aged walnut trees than in young ones.

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Clinical Usefulness of Thyrotropin Binding Inhibitor Immunoglobulin (TBII) Assay by the Comparative Method (측정법에 따른 갑상선자극호르몬 결합억제면역글로블린(TBII)의 임상적 유용성 검토)

  • Park, Hee-Won;Shin, Hee-Jung;Kim, Tae-Hoon;Noh, Gyeong-Woon;Kim, Hyun-Joo
    • The Korean Journal of Nuclear Medicine Technology
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    • v.13 no.3
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    • pp.175-180
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    • 2009
  • Purpose: Detection of TSH-binding inhibitor immunoglobulin (TBII) in patients with hyperthyroidism is an important result of Graves' disease (GD) and hyperthyroidism treatment. This has been made out an inspection by commercial radio-receptor assays. To increase the sensitivity and the specificity of the assay, many results of the assay were reported. In this study we evaluated the clinical usetulness of TBII assays by the Comparative method. Material and Methods: We were measured by using healthy control group (n=30, male=20, female=10) of Seoul National University Hospital Healthcare System Gangnam Center from January to March in 2009. Similarly, We were measured by using hyperthyroid (TSH<$0.05\;{\mu}IU/mL$, FT4>1.80 ng/dL) experimental group (n=58, male=14, female=44) of division of endocrinology and metabolism department of internal medicine Seoul National University Hospital from January to March in 2009. We made a comparative study of each two assays from the first generation to the third generation. We were used of TSAb assay as a measurement of GD diagnostic technique. Results: The specificity of healthy control group was 100% according to the generation. (Specificity=100%, n=30) The sensitivity of hyperthyroid experimental group were the first generation RSR<%> (79.3%, n=58), RSR (51.7%, n=58), the second generation RSR-CT (93.1%, n=58), BRAHMSCT (98.3%, n=58), the third generation ELISA (94.6%, n=56), ECLIA (97.7%, n=58) and TS-Ab<%> (93.5%, n=46). Conclusion: We were used of TSAb assay as a measurement of GD diagnostic technique, The result of data showed a high correlation between the third generation TBII assay and the second generation TBII assay ($R^2$=0.923). Instead of the first generation assay, the second generation assay can be more useful in clincal diagnosis.

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