• Archives of Plastic Surgery
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• 제37권3호
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• pp.281-284
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• 2010

Purpose: Pseudohypoparathyroidism is a hereditary disorder characterized by symptoms and signs of hypoparathyroidism, typically in association with distinctive skeletal and developmental defects. Hypoparathyroidism is caused by a insufficient end-organ response to PTH (parathyroid hormone). Hypoparathyroidism consists of four types in which the most common form, pseudohypoparathyroidism-Ia, accompany with Albright's hereditary osteodystrophy. We experienced a case of a woman who had been suffering from calcified mass on left foot, diagnosed Albright's hereditary osteodystrophy. Methods: We present a case of a 24-year-old Korean female who visited plastic surgery department with a painful mass on dorsum of the left foot. On the physical exam, bony hard and painful mass, fixed to dermis, was noted. Plain X-ray films demonstrate suspicious calcification on subcutaneous tissue of dorsum of the left foot. The patient was diagnosed pseudohypoparathyroidism 2 years ago at the plastic surgery department. At the visiting time, the laboratory results were within normal range even though the patient actually had a disease. The reason is because the patient has been treated with Vit.D, calcium replacement therapy and thyroid hormone therapy. Moreover, the patient has been treated with anticonvulsant agents due to epilepsy. On the brain computer tomography (CT), calcification was noted on the basal ganglia and dentate nucleus. So we decided the total excision of entire mass from the left foot. Results: We excised main mass with numerous pinhead sized masses which were scattered around the main mass. The $6.0{\times}4.0{\times}0.5\;cm$ sized main mass was bony hard, and its surface was flat and margin was irregular. The permanent biopsy was confirmed that the main mass and all the scattered tiny masses were heterotopic calcification. The patient did not suffer from the pain after the mass excision. The wound has been healed without any problem. Conclusions: Heterotrophic calcification is often accompanied with pseudohypoparathyroidism, but such a huge one is uncommon. We report a case of pseudohypoparathyroidism with heterotrophic calcification developed in dorsum of left foot who was diagnosed by excisional biopsy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제14권1호
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• pp.86-90
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• 2011

구리를 운반하는 P형 ATPase 단백을 합성하는 ATP7B 유전자의 돌연변이로 인하여 간, 뇌, 각막, 신장 및 적혈구 등 여러 조직에 구리가 축적되어 발병하는 상염색체 열성 유전 질환인 윌슨병은 간 증상과 신경증상이 주요 증상이지만 이외에도 용혈성 빈혈, 심장, 신장 및 내분비 이상 증상을 초래할 수 있다. 저자들은 윌슨병으로 진단되어 치료 받던 중 부갑상샘의 구리 침착에 의한 것으로 추측되는 부갑상샘저하증, 여러 복합요인에 의한 비타민 D 결핍 그리고 원인이 불명확한 저마그네슘혈증으로 인하여 발생한 테타니를 칼슘, 마그네슘 및 비타민 D 투여로 치료하였던 1예를 경험하였기에 보고하는 바이다.

• 대한두경부종양학회지
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• 제14권2호
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• pp.214-219
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• 1998

Objectives: To assess the effectiveness of the low-dose(30mCi) I-131 ablation therapy for remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer. Methods: Between March 1995 and December 1997, forty-eight patients were given ablative doses(30mCi) of I-131 after total thyroidectomy for differentiated thyroid cancer in the presence of I-131 uptake in remnant thyroid tissue. Effective ablation of remnant thyroid tissue was determined by following I-131 whole body scan. if remnant thyroid tissue remained, we repeated the same management at 6 months interval. Results: Thirty-eight(79.1%) patients had papillary, 8(16.7%) follicular, 1(2.1%) medullary and 1(2.1%) Hurthle cell type cancer. Forty-eight patients underwent total thyroidectomy, among those central neck dissection was performed in 35 cases, and modified radical neck dissection in 14 cases. Postoperative complication developed in 8 cases, which included 4 cases of transient hypoparathyroidism, 1 case of permanent hypoparathyroidism, 2 cases of transient recurrent laryngeal nerve palsy, and 1 case of wound hematoma. There were significant remnant thyroid tissue in 46 cases(95.8%) of patients after total thyroidectomy, which could be ablated by low dose(30mCi) I-131. There were no statistical difference between operative procedures and number of treatment of I-131. Conclusions: These results suggested that repeated low-dose(30mCi) I-131 therapy would be needed, therefore, high -dose I-131 therapy could be considered as ablation therapy for the remnant thyroid tissue after total thyroidectomy for differentiated thyroid cancer.

• 대한임상독성학회지
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• 제17권1호
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• pp.42-45
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• 2019

Dioscorea tokoro has long been used in Korean traditional medicine as a pain killer and anti-inflammatory agent. A 53-year-old male who consumed water that had been boiled with raw tubers of D. tokoro as tea presented with numbness and spasm of both hands and feet. Laboratory results showed hypocalcemia, hypoparathyroidism, and vitamin D insufficiency. During his hospital stay, colitis, acute kidney injury, and toxic encephalopathy developed. The patient received calcium gluconate intravenous infusion and oral calcium carbonate with alfacalcidol. His symptoms improved gradually, but hypocalcemia persisted despite the calcium supplementation. We suggest that ingestion of inappropriately prepared D. tokoro can cause symptomatic hypocalcemia in patients with unbalanced calcium homeostasis.

• 대한두경부종양학회지
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• 제9권1호
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• pp.16-24
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• 1993

During 7 years, from Jan. 1986 to Dec. 1992, authors studied 208 cases of the surgically managed thyroid nodules at the Department of General Surgery, Han Kang Sacred Heart Hospital and obtained the following results. 1) Among the total 208 cases, male to female ratio was 1:11.2 in benign thyroid diseases and 1:9 in malignant thyroid diseases. The benign disease was prevalent between second and forth decade comparing with malignant disease between third and fifth decade. 2) The most common duration of illness was 3 months(26.0%). 3) Palpable neck mass was the most common chief complaint(100%). Palpitation. fatigue, and sweating were common complaints in patient with benign disease, and fatigue, palpitation, and sweating in malignant disease in decreasing order of frequency. 4) 55.8 % of lesions were in right lobe, 33.2% in left lobe, 5.8% in diffuse type, 4.8% in bilateral lobes, and 0.5% in isthmus. 5) The most common size of nodule was between 2.0cm and 3.9cm in diameter, which consisted of 55.1% of benign disease and 48.0% of malignant disease. 6) 86.5% of thyroid function test showed euthyroidism, 10.1% hyperthyroidism, and 3.4% hypothyroidism. 7) Thyroid scanning of 176 patients revealed cold nodules in 92.5% of benign diseases and in 92.9% of malignant diseases. 8) The most common benign disease was adenomatous hyperplasia(62.7%), and the most common malignant disease was papillary adenocarcinoma(80.0%). 9) Fine needle aspiration cytology was performed in 91 cases, and it showed 69.0% of sensitivity, 90.3% of specificity, and 83.5% of accuracy. 10) Frozen biopsy was performed in 109 cases. and it showed 93.9% of sensitivity, 100.0% of specificity, and 98.2% of accuracy. 11) The most commonly performed operation was unilateral lobectomy(including unilateral lobectomy with isthmectomy)(79.1%) in benign disease. and total thyroidectomy(62.0%) in malignant disease. 12) Postoperative complication showed 5 cases of wound infection (2.4%), 3 cases of transient hypoparathyroidism(1.4%), 3 cases of transient hoarseness(1.4%), 2 cases of postoperative bleeding(1.0%), 1 case of permanent hypoparathyroidism(0.5%), 1 case of permanent hoarseness(0.5%), and 1 case of postoperative pneumonia (0.5%).

• Asian Pacific Journal of Cancer Prevention
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• 제13권10호
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• pp.5225-5228
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• 2012

Introduction : The objective of this study was to analyze the complication rates after completion thyroidectomy and compare them with primary total benign and malign thyroidectomy causes in total of 647 patients. Patients and Methods: Among 647 patients, there were 159 receiving completion thyroidectomy for differentiated thyroiud cancer (DTC) (Group 1); 217 patients receiving total thyroidectomy for DTC (Group 2) and 271 given total thyroidectomy for benign diseases (Group 3). Results: When groups were compared for complications, there were no significant difference except temporary hypocalcemia between completion thyroidectomy and total thyroidectomy for DTC. When the total thyroidectomies were compared (Group 2 and 3), there were no significant difference observed except unilateral temporary RLN palsy. Conclusion: With improvements in surgical technique and experience, complication rates of thyroidectomy performed for benign or malign diseases are reduced. In spite of the improvement in surgical experience, temporary RLN palsy and hypoparathyroidism are the main complications in completion thyroidectomies which need special attention. To evaluate the patients more carefully in preoperative period and performing adequate thyroidectomy appears more logical.

• 대한두경부종양학회지
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• 제10권2호
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• pp.106-111
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• 1994

During a 9-year period(March 1985 to February 1994), 111 consecutive total thyroidectomies and modified or radical neck dissections were performed at 81. Vincent Hospital, Catholic University Medical College, for benign and malignant disease. There were three permanent complications, persistent hypoparathyroidism, in total thyroidectomies. Overall complications were observed 20(62.5%) in benign diseases, 47(59.5%) in malignancy. In benign and malignant thyroid diseases. the complications were transient hypoparathyroidisms (28.8%), transient hoarsenesses(21.6%), wound infections (3.6%), bleedings(3.6%), and permanent hypoparathyroidisms(2.7%). Our experience suggests that the morbidity of total thyroidectomy relates primarily to the extracapsular extension, necessitating en bloc exision accompanied by additional lymph node dissection. The low incidence of permanent complications in thyroid disease suggests the feasibility of total thyroidectomy as the operation of choice when surgeons are familiar with the technique and indications.

• 대한치과마취과학회지
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• 제13권3호
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• pp.139-143
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• 2013

The patient who has congenital hypothyroidism and pseudohypoparathyroidism could have mental retardation even though adequate hormone treatment and cannot endure conventional dental treatment. In this case, general anesthesia is selected to administer effective dental treatment. But, there could be symptoms such as anemia, neuropathy, associated pituitary or adrenal hypofunction, cardiac failure even in euthyroid state. And, bradycardia, mental dullness, hypothermia, slow reflexes can appear in case of inadequate thyroid hormone replacement. Especially, macroglosssia, slow drug metabolism, exaggerated responses to anesthetic agents and decreased ventilatory responses could be problem during general anesthesia. The presentation of hypoparathyroidism also varies depending on the chronicity of the result of hypocalcemia. Muscle spasms/tetany, paresthesias, and seizures may occur in an acute onset. Chronic hypocalcaemia causes fatigue, muscle cramps, lethargy, personality changes, and cerebration defects.

• 대한두경부종양학회지
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• 제13권1호
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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.

• 대한두경부종양학회지
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• 제8권1호
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• pp.14-20
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• 1992

To clarify the safety of both total and near-total thyroidectomy, and to guide a selectionof an adequate type of surgical treatment of thyroid diseases, 192 consecutive total or near-total thyroidectomy cases were reviewed. They were divided into two groups: ont, the total thyroidectomy group(Group T,N=111) and the other, the near-total thyroidectomy group (Group NT, N=81). In both groups, complication rates, associations of complication rates with extents of surgery and stage of lesion were observed. Complication rate was significantly higher in Group T (53.6% vs 12.3%, p<0.05). But the rate of permanent complications such as permanent hypoparathyroidism and recurrent laryngeal nerve injury was remarkably low(4.5% in Group T, 6.0% in Group NT) and shows no significant difference in both groups. There was no permanent complication in cases where any type of neck dissection had not been performed regardless of the type thyroidectomy. But among whom underwent central compartmental neck dissection(CCND) and functional neck dissection(FND), 4(4.4%) and 4(6.4%) cases showed permanent complications. There was no statistical significance in differences between Group I and NT. In cases who underwent concomittant classical radical neck dissection(RND), 3(25.5%) showed permament complications. In this subgroups, complications were significantly higher in Group T(p<0.005). Complications were also directly related to the stage of the lesion. Only one patient showed permanent complication in 74 intracapsular lesions but 9 permanent complications were observed in 118 advanced lesions. We could clarify both total and near-total thyroidectomy were safe operations and the complications were related to accompanying neck dissections and the disease status rather than total or near-total thyroidectomy itself. Thus, we think that for the cases where higher complication rates are expected, such as locally advanced thryoid cancers or the cases which required wider neck dissection, the near-total thyroidectomy would be a preferrable method.