• 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.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.3
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• pp.86-91
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• 2009

Purpose: The whole body scan in Nuclear Medicine is a widely accepted examination and procedure. Especially, it is mainly used in bone, I-131, MIBI, and HMPAO WBC scans. The diverse uses of the whole body scan range from the HMPAO WBC scan with a speed of 13cm/min, to a whole body bone scan using the Onco. Flash technique with a speed of 30cm/min. The accuracy of table movement has a strong correlation with the image quality, and inaccuracy of speed could negatively affect the image quality. The purpose of this study is to evaluate the accuracy of the table movement while considering the influence of the age of the equipment and the variability in the weight of the patients. Material and Methods: The study was conducted using two of Seoul Asan Medical Center's SIEMENS gamma cameras which are commonly used in our whole body study. The first one is the oldest gamma camera, an ECAM plus (installed in 2000), and the last is brand new one, a SYMBIA T2 (installed in 2008). Three trials were conducted with the tables moving at a different speed each time; 10, 15 and 30 cm/min. The tables' speeds were measured by checking how long it took for the table to move 10cm, and this was repeated every 10cm until the table reached 100 cm. With an average body weight of the patients of about 60~70 kg, the table speed was measured with weights of 0 kg, 66 kg and 110 kg placed on the table, then compared among conditions. Results: The coefficient of variance (CV) of the ECAM plus showed 1.23, 1.42, 2.02 respectively when the table movement speeds were set at 10, 15, and 30 centimeters per minute. Under the same conditions, the SYMBIA T2 showed 1.23, 1.83 and 2.28 respectively. As table movement speed more, the variance of CV as the speed increases. When the patient body weight was set to 0, 66 and 110kg, the CV values of both cameras showed 0.96, 1.45, 2.08 (0 Kg), 1.32, 1.72, 2.27 (66 Kg) and 1.37, 1.73, 2.14 (110 Kg). There was no significant difference (p>0.05) in 95 percent of confidence intervals and measured CV values were acceptable. However, the CV value of the SYMBIA T2 was relatively larger than the ECAM plus. Conclusion: The scan speed of the whole body scan is predetermined based on which examination is being performed. It is possible for the accuracy of the speed to be affected, such as the age of the equipment, the state of the bearings or the weight of a patient. These factors can have a negative impact on the diagnostic consistency and the image quality. Therefore, periodic quality control should be needed on the gamma cameras currently being used, focusing on the table movement speed in order to maintain accuracy and reproducibility.

• The Korean Journal of Nuclear Medicine
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• v.8 no.1_2
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• pp.49-55
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• 1974

The authors studied on the 5 cases of solitary thyroid nodule by T3 suppression test and TSH stimulation test. Radioiodine uptake and thyroid scan were observed after administration of dssicated thyroid and TSH. 3 of 5 cases were teated by $^{131}I$ and 2 by long-term adiministration of dessicated thyroid. Following were the results: 1. Nodular tissue was not affected by the administration of dessicated thyroid or TSH. 2. Extranodular tissue responded as normal thyroid tissue on the administration of dessicated thyroid or TSH. 3. There were many gradations from euthyroid to hyperthroid in clinical state. 4. Treatments were succesful in all cases except one case who was treated by long-term administration of dessicated thyroid.

• Korean Journal of Head & Neck Oncology
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• v.12 no.2
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• pp.235-240
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• 1996

Brain metastasis is extremely rare in thyroid papillary carcinoma which has an indolent clinical course and results in good prognosis. A 24-year-old man presenting with seizure attack is described. He had been treated under the diagnosis of thyroid papillary carcinoma with total thyroidectomy, postoperative internal radiation with radioactive iodine, and thyroid hormone replacement. Although $^{99m}$Tc brain spect and $^{131}$I whole body scan did not revealed any significant lesion, brain CT and MRI showed lcm sized mass in frontal lobe. Stereotactic craniotomy and removal of the tumor, which was histologically proven metastatic lesion from thyroid papillary carcinoma, was done with satisfactory improvement.

• The Korean Journal of Nuclear Medicine
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• v.24 no.2
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• pp.293-298
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• 1990

We performed 17 intraarterial scintigraphies in six patients with recurrent cervix cancer. With Seldinger method, the agent (four different radiopharmaceuticals) was perfused at the same speed of infusion of anticancer drugs (25 cc/hour) through internal iliac artery. There were four different radiopharmaceuticals; I-131-Lipiodol, Tc (Technetium)-99m-HSa (Human Serum Albumin), $^{99m}Tc-Sucralfate$ and $^{99m}Tc-MAA$ (Macroaggraegated Albumin). We evaluate the distribution pattern of radioactivity by the use of ratio of Tumor/Extratumor uptake (T/ET ratio). Our results reveals that $^{99m}Tc-MAA$ scan showed the highest T/ET ratio and the other were not ideal agents for intraarterial therapy of recurrent cervix cancer. In conclusion, an ideal radioisotope and tracer which can block capillary, for example MAA, should be re-evaluated or produced in order to treat the patient with recurrent cervix cancer.

• Korean Journal of Head & Neck Oncology
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• v.13 no.1
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• pp.45-50
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• 1997

Total thyroidectomy has been advocated as the treatment of choice for most well differentiated thyroid carcinomas. Many surgeons have an aversion to total thyroidectomy, however, because of an allegedly high frequency of complications as compared with those resulting from other operation methods. In this report we reviewed our experience with 37 consecutive total thyroidectomy(January 1995 to December 1996). The clinical features are similar to other studies. The sex ratio is 1 : 3.1(M : F), third decade occupies 33% of cases. The anterior neck mass is the most frequent symptom(95%). In the duration of symptom, 35% of patients was within 3 months. Thirty five cases are cancer, and two cases are Hashimoto's thyroditis. The papillary carcinoma is the most common pathologic type(86%). Total thyroidectomy was done in 20 cases, and total thyroidectomy with modified neck dissection was done in 17 cases. The five postoperative complications occurred in 3 patients among 37 patients: postoperative bleeding in 1, transient hoarseness in 2, transient hypoparathyroidism in 2. Thirty four cases received $I^{131}$ scan and therapy, two cases received thyroid hormone replacement, and one case received chemotherapy. We think that total thyroidectomy can be done without additional risk compared with other thyroid operation methods, with meticulous and careful surgical technique.

• The Korean Journal of Nuclear Medicine
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• v.31 no.1
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• pp.108-115
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• 1997

$^{131}I-6{\beta}$-iodomethyl-19-norcholesterol(NP-59) has an advantage to assess adrenal dysfunction caused by adrenal cortical disorders. The aim of this study is to evaluate the clinical usefulness of NP-59 scintigraphy in each adrenal disease. Ten patients who did eleven NP-59 adrenal scintigraphies at Dong-A University Hospital from March 1990 to December 1996 were selected as the subject. Among the subject there were 5 cases of Cushing's syndrome, 2 cases of incidentaloma, 1 case of metastatic adrenal tumor, liver cirrhosis with hirsutism and hypertension respectively. Among 5 cases of Cushing's syndrome, there were 2 cases of Cushing's disease, 2 cases of adrenal adenoma and 1 case of adrenal carcinoma. There are no disagreement between clinical diagnosis and scan finding in Cushing's syndrome. In 2 incidentaloma cases, even though one is interpretated as a functioning tumor, both of 2 cases could avoid unnecessary biopsy according to scintigraphy result. One case of hirsutism, clinically adrenal originated, revealed the normal scintigraphic finding after dexamethasone suppression scan. It could suggest that the etiology of hirsutism was extra-adrenal origin. One case of hypertension took the study to exclude the possibility of primary aldosteronism. Normal suppression scan finding revealed that primary aldosteronism did not exist in this case. In conclusion, NP-59 scintigraphy was very useful in diagnosis and differential diagnosis of Cushing's syndrome and it could avoid unnecessary biopsy in the incidental adrenal tumor.

• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.149-152
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• 2014

Purpose: At our hospital blood is collected from a patient before an imaging test, with the concern of any effect possible when a nuclear medicine imaging test and an in-vitro test are carried out at the same time. However, occasionally, the blood collection is performed after an imaging test, with the reasons that the patient is not properly guided or the patient doesn't follow the guide correctly. In that case, we prefer to gather blood again after a few days. The purpose of this study is not only to see whether there is any effect of an imaging test on the result of the in-vitro test performed with the blood collected after the imaging test, but also to study how many days waiting after each test is appropriate to take a blood sample, if the effect exists. Materials and Methods: From September to October 2013, blood were collected from 13 patients in our hospital regardless of age and sex each time before and after the injection of the radioactive isotope from the tests : PET-CT, Gated Myocardial SPECT, and DTPA GFR Scan. Considering a half-life, AFP, CA19-9, CEA, TSH, and T3 were carried out right after the blood collection. In case of an iodine therapy, blood were taken each time before and after taking radioactive iodine, and, after AFP, CA19-9, and CEA, the difference between them in consistency and in cpm were compared. Results: With 10 patients after the imaging tests and 3 patients after the iodine therapy, their serum cpm was over 10,000. Over time, the cpm decreased in accordance with the half-life ($^{18}F$ 110minutes, $^{99}mTc$ 6hours, $^{201}Tl$ 72hours, $^{131}I$ 7days). Between the two cases, one before and the other after the injection of the radioactive isotope, the cpm and the results of AFP, CA19-9, CEA, TSH, and T3 from three patients each test, PET-CT, Gated Myocardial SPECT, and DTPA GFR Scan, were very similar. In addition, in case of an iodine therapy, there was also not a meaningful difference in the cpm and the results of AFP, CA19-9, and CEA, from three patients in an iodine therapy, between the two cases, one before and the other after taking the radioactive iodine. Conclusion: In case a blood collection was performed after the imaging test which required a radioactive isotope injection, the cpm increased, differently according to the kind of the radioactive isotope. However, the results of the in-vitro tests like AFP, CA19-9, CEA, TSH, T3, etc were nearly not affected. As the result, it's considered that there will not be any significant effect also from other tests, as the result from the performed seven tests.

• Tuberculosis and Respiratory Diseases
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• v.62 no.5
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• pp.417-420
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• 2007

Sarcoidosis is a multisystemic granulomatous disease with an of unknown etiology, involving bilateral hilar lymphadenopathy, pulmonary, skin and eye lesions. However, involvement of the endocrine system in sarcoidosis is quite rare, and the coexistence of both diseases is extremely unusual. We describe a 60-year-old woman presenting with sarcoidosis and Graves' disease. She was admitted for evaluation of dry cough, dyspnea, palpitation and general weakness. Both thyroid glands were enlarged diffusely. The thyroid function tests showed suppressed serum thyrotropin and an increased thyroid hormone level. The levels of the TSH receptor antibody, anti-thyroglobulin antibody and anti-microsomal antibody were higher than normal. The radionuclide scan($^{131}I$) showed increased iodine uptake. The chest X-ray revealed pulmonary hilar enlargement and high resolution CT showed both hilar lymph nodes enlargement and tiny parenchymal nodules. The transbronchial lung biopsy showed a noncaseating granuloma without necrosis. We report this case of pulmonary sarcoidosis plus Graves' disease with a review of the relevant literatures.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.3
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• pp.1115-1118
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• 2016

Background: There is controversy about ablation efficacy of low or high doses of radioiodine-131 (RAI) in patients with differentiated thyroid cancers (DTC). The purpose of this prospective study was to determine efficacy of 30 mCi and 100 mCi of RAI to achieve successful ablation in patients with low to intermediate risk DTC. Materials and Methods: This prospective cross sectional study was conducted from April 2013 to November 2015. Inclusion criteria were patients of either gender, 18 years or older, having low to intermediate risk papillary and follicular thyroid cancers with T1-3, N0/N1/Nx but no evidence of distant metastasis. Thirty-nine patients were administered 30 mCi of RAI while 61 patients were given 100 mCi. Informed consent was acquired from all patients and counseling was done by nuclear physicians regarding benefits and possible side effects of RAI. After an average of 6 months (range 6-16 months; 2-3 weeks after thyroxin withdrawal), these patients were followed up for stimulated TSH, thyroglobulin (sTg) and thyroglobulin antibodies, ultrasound neck (U/S) and a diagnostic whole body iodine scan (WBIS) for ablation outcome. Successful ablation was concluded with stimulated Tg< 2ng/ml with negative antibodies, negative U/S and a negative diagnostic WBIS (triple negative criteria). ROC curve analysis was used to find diagnostic strength of baseline sTg to predict successful ablation. Results: Successful ablation based upon triple negative criteria was 56% in the low dose and 57% in the high dose group (non-significant difference). Based on a single criterion (follow-up sTg<2 ng/ml), values were 82% and 77% (again non-significant). The ROC curve revealed that a baseline sTg level ${\leq}7.4ng/ml$ had the highest diagnostic strength to predict successful ablation in all patients. Conclusions: We conclude that 30 mCi of RAI has similar ablation success to 100 mCi dose in patients with low to intermediate risk DTC. A baseline $sTg{\leq}7.4ng/ml$ is a strong predictor of successful ablation in all patients. Low dose RAI is safer, more cost effective and more convenient for patients and healthcare providers.