• 대한핵의학회지
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• 제20권1호
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• pp.53-58
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• 1986

Thyroid scans using $Na^{131}I\;and\;^{99m}TcO_4^-$ in two (anterior and anterior oblique) projections were done simultaneously in 50 patients with single palpable nodule and in euthyroid state(nodular nontoxic goiter) and 20 normal subjects to evaluate the imaging ability of each radionuclide and the necessity of oblique view. In detection of a nodule as a cold or cool area, $^{99m}TcO_4^-$ was slightly superior to $^{131}I$(82 % to 78% with anterior view alone, 92% to 84% when oblique view is added in detectability), with addition of an oblique view, 5 more cold or cool area in $^{99m}Tc$ scan and 3 more $^{131}I$ scan were detected. In normal subjects $^{99m}TcO_4^-$ scan was significantly superior to $^{131}I$ scan(90% to 70%) in getting normal pattern of tracer uptake in the glands. For routine imaging study of the thyroid, $^{99m}Tc$ pertechnetate scan with multiple projection is considered to be a preferable method.

• 대한핵의학회지
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• 제35권4호
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• pp.286-287
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• 2001

A 44 year-old male patient was undergoing diagnosis and therapy for acute myelogenous leukemia (AML, M2). On physical examination a thyroid mass was palpated in the left lower lobe. He had palpitation and intolerance to heat. Thyroid function tests revealed hyperthyroidism; T3: 150ng/dl (N:60-90), fT4: 2.26 ng/dl (N:0.70-1.80), TSH: 0.01 ulU/ml (N:0.25-5.00). Ultrasonography demonstrated a hypoechoic mass with scattered calcifications measuring 2.55 2.03 3.64 cm in size. F-18 FDG camera-based PET scan performed as a follow-up study of AML revealed a focal increased uptake in the left neck, where an autonomous nodule was detected on Tc-99m thyroid scan. After the diagnosis of toxic autonomous nodule, Goetz disease, he underwent surgical nodulectomy. Microscopically, the nodule contained follicular proliferation with degenerative change but without evidence of thyroid carcinoma. Focal uptake in autonomous thyroid nodules is due to increased glycolysis within the nodules.

• 대한핵의학회지
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• 제35권3호
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• pp.117-124
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• 2001

Serum thyroglobulin measurement and I-131 whole-body scintigraphy (WBS) are well-established methods for the detection of recurrence in the follow-up of patients with thyroid carcinoma. However, inconsistent results are observed frequently, and these two methods are not always able to detect recurrence. In some patients, serum thyroglobulin level is elevated but the WBS is negative, because the recurrent tumor is too small and below the sensitivity of the diagnostic scan, or there is a dissociation between thyroglobulin synthesis and the iodine frapping mechanism. In such cases, various nuclear imaging methods including Tl-201 Tc-99m-sestamibi, and F-18-FDG PET can be used besides anatomical imaging methods. Among them, FDG PET localizes recurrent lesions in WBS-negative thyroid carcinoma with high accuracy. Several studies have suggested that empirical high-dose I-131 therapy resulted in a high rate of visualization in post-therapy scans with evidence of subsequent improvement. An important question is when to operate on patients with recurrent tumor. We believe that surgical removal is the best means of treatment for patients with localized persistent tumor, despite the high-dose I-131 therapy. with tumor in thyroid remnant, and with isolated recurrence in the lymph node, lung or bone. In addition, we recommend palliative resection of locally unresectable mass with subsequent treatment with high-dose I-131 therapy. Before I-131 therapy, the evaluation of sodium-iodide symporter expression in thyroid carcinoma can predict iodine uptake. Retinoic acid is known to induce redifferentiation, and to enhance I-131 uptake in thyroid carcinoma. Retinoic acid therapy may represent an alternative approach before high-dose I-131 therapy.

• 대한핵의학회지
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• 제39권6호
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• pp.489-490
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• 2005

Purpose: The thyroglossal duct runs from the base of the tongue to the thyroid. Rarely the thyroid completely fails to migrate and results in ectopic thyroid tissue, which can be demonstrated scintigraphically. A 31-year old female patient was referred for thyroid scintigraphy due to protruding mass at the base of the tongue. She was mildly hypothyroid. Te-99m pertechnetate thyroid scan was performed to rule out ectopic thyroid gland. There showed a focal area of intense tracer uptake in sublingual area, suggesting the sublingual thyroid. In addition there noted diffusely increased tracer uptake in both breasts. The patient delivered a baby 6 months prior to the scan and was on breast-feeding. Free Tc-99m pertechnetate physiologically secrets into the salivary glands, the stomach, the gastrointestinal tract, the genitourinary tract and the mammary glands and sodium-iodide symporter plays a role in the accumulation of free Tc-99m pertechnetate. We report simultaneous visualization of lactating breasts and ectopic thyroid gland in the base of the tongue.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2523-2527
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• 2014

Background: Serum thyroglobulin detection plays an essential role during the follow-up of thyroid cancer patients treated with total/near total thyroidectomy and radioiodine ablation. The aim of this retrospective study was to evaluate the relationship between stimulated serum thyroglobulin (Tg) level at the time of high dose $^{131}I$ ablation and risk of recurrence, using a three-level classification in patients with differentiated thyroid cancer (DTC) according to the ATA guidelines. Also we investigated the relationship between postoperative stimulated Tg at the time of ablation and DxWBS results at 8-10 months thereafter. Materials and Methods: Patients with radioiodine accumulation were regarded as scan positive (scan+). If there was no relevant pathological radioiodine accumulation or minimal local accumulation in the thyroid bed region, this were regarded as scan negative (scan-) at the time of DxWBS. We classified patients in 3 groups as low, intermediate and high risk group for assessment of risk of recurrence according to the revised ATA guidelines. Also, we divided patients into 3 groups based on the stimulated serum Tg levels at the time of $^{131}I$ ablation therapy. Groups 1-3 consisted of patients who had Tg levels of ${\leq}2ng/ml$, 2-10 ng/ml, and ${\geq}10ng/ml$, respectively. Results: A total of 221 consecutive patients were included. In the high risk group according to the ATA guideline, while 45.5% of demonstrated Scan(+) Tg(+), 27.3% of patients demonstrated Scan(-) Tg(-); in the intermediate group, the figures were 2.3% and 90.0% while in the low risk group, they were 0.6% and 96.4%. In 9 of 11 patients with metastases (81.8%), stimulated serum Tg level at the time of radioiodine ablation therapy was over 10, however in 1 patient (9.1%) it was <2ng/mL and in one patient it was 2-10ng/mL (p=0.005). Aggressive subtypes of DTC were found in 8 of 221 patients and serum Tg levels were ${\leq}2ng/ml$ in 4 of these 8. Conclusions: We conclude that TSH-stimulated serum thyroglobulin level at the time of ablation may not determine risk of recurrence. Therefore, DxWBS should be performed at 8-12 months after ablation therapy.

• 대한핵의학회지
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• 제27권2호
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• pp.183-190
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• 1993

저자들은 이소갑상선이 의심되어 갑상선신티그라피로 확진된 19명의 환자를 대상으로 갑상선 스캔과 갑상선 기능검사의 결과 및 임상증상등을 조사하여 다음과 같은 결과를 얻었다. 1) 이소갑상선의 성별분포는 여자 16명, 남자3명으로 여자가 남자의 5.3배였고, 30세 이전인 경우가 97%였다. 2) 이소갑상선이 발견된 위치는 설근부 10예, 설하부1예, 전 후두부 5예 그리고 Combined form이 3예였다. 3) 갑상선기능검사를 시행한 16예에서 갑상선기능저하증이 7예, 준임상적 갑상선기능저하증이 4예 그리고 갑상선기능 정상이 5예였다. 4) 설갑상선의 경우는 갑상선기능저하증이 90%에서 나타났으나, 이보다 아래로 내려온 경우에는 33%로 갑상선 기능이상은 이소갑상선의 위치에 따라 유의한 차이가 있었다(p<0.05). 5) 갑상선의 주된 임상증상은 설근부의 인후이물감, 연하곤란이었고, 이보다 아래에 위치한 경우는 전경부의 종괴가 주된 임상증상이었다. 6) 갑상선기능저하증으로 진단된 7예와 준임상적 갑상선 기능저하증 4예중 3예에서는 갑상선호르몬을 투여하였고 갑상선 기능이 정상인 2예에서 이소갑상선 제거술이 시행되었으며 그 나머지는 추적관찰하였다. 7) 설근부나 전경부에 종괴가 있을 경우에는 반드시 갑상선스캔을 시행하여 이소갑상선의 가능성을 배제하여야 한다. 또한 이소갑상선의 기능이 정상인 환자에서도 갑상선기능저하증으로 진행될 수 있으므로 추적관찰이 필요하다.

• 핵의학기술
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• 제18권1호
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• pp.98-103
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• 2014

갑상선 분화암 환자의 방사선 치료에서 I-131의 유효반감기는 환자에게 투여하는 양의 계산뿐만 아니라 환자의 격리 입원기간의 결정, 환자로부터 가족들이 받게 되는 선량을 계산하는데 유용한 값이다. 하지만 이 값은 물리적반감기와는 달리 실측을 해야만 얻을 수 있어 입원 격리중인 환자에게 계측하기가 기술적으로 어려운 문제가 있다. Dual time I-131 whole body scan의 초기촬영과 지연촬영 사이의 체내잔류방사능량을 이용하여 전신과 갑상선에 유효반감기를 추정해 보았다. 또한 혈중 크레아티닌 농도, GFR, 투여량이 유효반감기와 상관관계가 있는지 알아보았다. 유효반감기 측정을 위해 전신에 체내잔류방사능량과 갑상선의 잔류방사능량을 측정하기 위해 환자의 전신을 흥미영역으로 설정한 후 배후방사능을 보정하여 전신의 체내잔류방사능량을 획득하였고, 갑상선 부위에 ROI를 설정한 후 배후 방사능을 보정하여 갑상선의 잔류방사능량을 획득하였다. 초기영상과 지연영상의 측정값 사이의 비율을 계산하여 전신과 갑상선의 유효반감기를 구하였다. 또한 유효반감기와 GFR, 혈중크레아티닌 농도, I-131 투여량과의 상관관계를 분석하였다. 전신의 체내잔류방사능량을 측정한 값의 유효반감기는 $17.06{\pm}5.50$시간으로 나타났고 갑상선의 잔류방사능량을 측정한 값의 유효반감기는 $17.22{\pm}5.41$시간으로 나타났으며 두 유효반감기는 유의한 차이를 보이지 않았다(P=0.887). GFR 값이 올라갈수록 전신의 유효반감기(r=-0.407, P=0.003)와 갑상선 유효반감기(r=-0.473, P=0.001) 모두 유의하게 감소하였으며 혈중크레아티닌 농도가 올라갈수록 전신의 유효반감기(r=0.309, P=0.029)와 갑상선 유효반감기(r=0.371, P=0.008) 모두 유의하게 증가하였다. 투여량은 두유효반감기와 상관관계를 보이지 않았다. 본 연구를 통해 고용량 방사성요오드 치료환자 입원기간의 최적화 연구와 기존 유효반감기를 구하기 위해 종사자의 피폭 및 복잡성을 보완하여 간편하게 측정을 할 수 있을 것이라 생각한다. 또한 분석된 갑상선의 유효반감기를 적용한 MIRD schema의 내부피폭선량 평가 연구에도 활용할 수 있을 것으로 사료된다.

• 한국방사선학회논문지
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• 제13권2호
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• pp.147-151
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• 2019

흉부 및 복부 CT 검사 시 산란선에 의한 안구와 갑상선의 방사선 피폭선량을 측정하고, 피폭선량의 감소를 위해 차폐체를 사용함으로써 방사선 피폭 정도를 조사하였다. 임상에서 사용되는 흉부 및 복부 CT 검사 프로토콜을 적용하여 안구와 갑상선의 차폐체 사용 전과 후의 선량을 측정하여 비교하였다. 안구와 갑상선의 표면선량은 OSLD를 사용하여 측정하였다. 산란선을 차폐하기 위해 바륨, 텅스텐 시트와 고글과 목 차폐체를 사용하였다. 흉부 CT 스캔 시 차폐를 하지 않고 스캔한 안구는 3.01 mSv, 갑상선은 6.21 mSv로 측정 되었고 복부 CT 스캔 시 차폐를 하지 않고 스캔한 안구는 0.55 mSv, 갑상선은 3.22 mSv를 나타내었다. 바륨과 텅스텐 시트는 흉부 CT 검사 시 안구와 갑상선의 차폐율이 11~13%이었고, 복부 CT 검사 시에는 34~49%까지 방사선 피폭의 저감 효과가 있었다. 흉부 및 복부 CT 검사 시 방사선 피폭 정도가 상당하기 때문에 검사가 반복, 지속적으로 이루어진다면 방사선 피폭으로 인해 갑상선 암, 백내장 등 방사선 위해가 발생할 가능성이 있어 검사 시 차폐체를 사용하는 것이 요구된다.

• 대한두경부종양학회지
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• 제13권1호
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• pp.69-73
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• 1997

We have experienced a case of occult papillary thyroid carcinoma presenting as an anterior mediastinal mass in a 40-year-old man. The CT scan revealed a huge mass behind the manubrium of the sternum but the ultrasound examination failed to detect any lesion and developmental defect in the thyroid. Excision of the mediastinal mass and total thyroidectomy were carried out. Histologically, the mediastinal mass turned out to be papillary carcinoma without any portion of the normal thyroid tissue or normal lymph node tissue and the thyroid gland showed a tiny papillary carcinoma with the diameter of 0.3cm. Although a mediastinal mass as the sole presentation of the thyroid carcinoma is very rare, we suggest that a mediastinal mass should be added to the list of possible metastatic thyroid carcinoma.

• Journal of Breast Cancer
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• 제21권4호
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• pp.463-467
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• 2018

Metastasis from primary cancer to the thyroid is uncommon in breast cancer. Here we present a case of lobular breast carcinoma that metastasized to the thyroid. A 54-year-old woman without symptoms was admitted to our institution for staging of the lymph node above the left clavicle. An $^{18}F$-fluoro-deoxy-D-glucose positron emission tomography scan was performed for staging, and low uptakes were observed in the left supraclavicular and cervical lymph nodes. High uptake was seen in the posterior and lower left lobe of the thyroid. Histologic findings indicated lobular breast carcinoma (positive GATA3, loss of E-cadherin expression) metastatic to the thyroid with a luminal profile. Immunohistochemical analysis was negative for primary thyroid or parathyroid carcinoma. To our knowledge, this is the first report of a patient presenting a metastatic invasive lobular carcinoma in the thyroid and lymph nodes without a prior diagnosis of breast cancer.