• The Korean Journal of Nuclear Medicine
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• v.35 no.3
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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.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.113-116
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• 2010

The initial presentation of distant metastases in patients with papillary thyroid carcinoma is quite rare. Most distant metastases are solid nodular lesions. A 67-year-old man who complained of severe dyspnea underwent surgery due to a large mediastinal cystic mass compressing the trachea and great vessels. Pathologically, the cystic mass was a metastatic thyroid papillary carcinoma. The thyroid evaluations were compatible with a well differentiated thyroid carcinoma. An occult thyroid carcinoma presenting as a large mediastinal cystic lesion is extremely rare.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.151-158
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• 1995

Anaplastic carcinoma of thyroid gland account for no more than 10% of thyroid cancer, but it shows extremely poor prognosis. The purpose of this study is to review the outcome of patients with anaplastic carcinoma over the span of 5 years and to determine the patterns of clinical presentation, age, sex and other possible prognostic variables. We analyzed 30 cases of anaplastic carcinoma retrospectively from 1991 to 1995. There were 14 men and 16 women. There age ranged 33 to 75 years with a mean of 61.0 years. Sixteen patients presented with transformationqr of well differentiated carcinoma to anaplastic carcinoma, 1 with rapid in-crease in the size of long standing goiter, 8 with rapidly growing neck mass and 4 with meta static disease. Twenty-eight patients(93.3%) showed cervical lymphnode metastasis at presentation and twenty three patients(76.6%) showed laryngotracheal invasion. Nine patients (30.3%) showed distant metastasis. Treatment modalities included surgical resection, external irradiation, radioactive iodine and systemic chemotherapy. At decision making of treatment plan, we considered completeness of initial surgery, uptake rate of whole body radioactive io-dine scan, locoregional progression and distant metastasis. The median survival was 6.8 months and three cases survived beyond 12 months.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.1
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• pp.79-82
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• 2009

A 73-year-old man presented with a chief complaint of progressive left knee pain for two months. He had a history of total thyroidectomy and central lymph node dissection due to papillary thyroid carcinoma three months ago. MRI images revealed a solid mass in the left patella. A solid mass demonstrated low signal on T1 weighed image, and high signal on T2 weighed image. And whole body bone scan showed focal photon defect in same lesion of left patella. The histologic result of left knee lesion was adenocarcinoma, consistent with metastatic papillary thyroid carcinoma. Although patellar metastasis of papillary thyroid carcinoma is very rare, when knee pain and radiologic abnormality are noted, differential diagnosis of metastasis is necessary.

• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.50-53
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• 2007

Adrenal metastasis from papillary thyroid carcinoma is extremely rare. We present herein a patient with adrenal metastases from recurrent papillary carcinoma of the thyroid. A 54 year-old woman had received a total thyroidectomy and postoperative radioactive iodine therapy for locally advanced papillary thyroid carcinoma. One year after initial surgery, distant metastases to multiple organs including right cervical lymph nodes, left upper lung, left 2nd and 3rd ribs, 2nd thoracic vertebra and left adrenal gland were found by 18-FDG-PET-CT whole body scan. She underwent right modified neck dissection, partial resection of left 2nd and 3rd ribs, posterior arch of 2nd thoracic vertebra, left upper lobectomy of lung, and left adrenalectomy. On histologic examination, metastases to the left adrenal gland and cervical lymph nodes were papillary thyroid carcinomas, while other metastatic sites turned out to be anaplastic thyroid carcinomas. Despite aggressive surgery and postoperative adjuvant therapy, her general clinical conditions were getting worse day by day due to regrowing of the anaplastic thyroid carcinomas. To our knowledge, this is the first case reported in Korea.

• Korean Journal of Head & Neck Oncology
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• v.13 no.2
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• pp.241-246
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• 1997

It has become evident in recent years that parathyroid adenoma and well differentiated thyroid cancer occur together more than would be expected by chance alone. However, the association between them is not well understood. We have experienced 4 cases of coexistent parathyroid adenoma and well-differentiated thyroid cancer during the past 16 years. None of them had a familial incidence or a history of radiation exposure. Three cases showed symptomatic hypercalcemia(including renal stones, bone pain, joint pain) and in two of them(patient 1 and patient 2), thyroid abnormalities were detected preoperatively by neck ultrasonography or neck CT for evaluation of parathyroid lesions. However, in patient 3, a parathyoid humor was identified and removed incidentally during the course of thyroidectomy. In 3 cases, surgeries for thyroid carcinoma and parathyroid adenoma were performed during the same exploration of the neck, but in patient 4, thyroidectomy preceded parathyroidectomy; The interval between thyroidectomy and subsequent parathyroidectomy was 11 yeras. The thyroid tumors in 3 cases were papillary carcinoma, the sizes of which ranged from 1.0 cm to 1.5 cm in greatest diameter. The remaining case(patient 4) was minimal invasive follicular carcinoma. Total or near-total thyroidectomy with various types of cervical lymphnode dissection and bilateral neck exploration for the parathyroid lesion was performed in 3 cases with papillary carcinoma. Ipsilateral lobectomy and contralateral partial thyroidectomy with consequent unilateral neck exploration for the parathyroid tumor was performed in the case of follicular cancer. In our experience, parathyroid adenoma and well-differentiated thyroid carcinomas can be coexistent and we felt that the attention to the hypercalcemic patients would be needed for detection of this rare condition.

• The Korean Journal of Nuclear Medicine
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• v.24 no.1
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• pp.80-86
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• 1990

Fifty seven patients with differentiated thyroid carcinoma were performed radioactive iodine-131 whole body scans after administration of diagnostic dose $(2\sim10\;mCi)$ and therapeutic dose $(30\sim150\;mCi)$ within three months. We evaluated the state of radioactive iodine-131 uptakes in whole body scan to detect correct metastasis of thyroid carcinoma. The results are as follows: 1) In 20 of the 57 patients (35%), the therapeutic scan showed the additional uptakes that were not seen in the diagnostic scan. 2) In 9 (64.2%) of the 14 patients who had been received the thyroid ablation theraphy with I-131 previously, new additional lesions were found in the therapeutic scan but only 11 (25%) of the 32 patients who had not been received the thyroid ablation theraphy disclosed new uptake lesions (p < 0.01). 3) The additional uptake lesions of therapeutic scan were significantly more common in the bony metastatic foci (55.7%) than other areas (p < 0.01). In 11 (55%) of 20 patients, additional uptake regions were anterior neck areas (thyroid bed or regional lymph node). We conclude that diagnostic scan with $2\sim5$ mCi I-131 is inadequate in evaluating residual iodine avid tissues of patients with thyroid carcinoma. Also post-theraphy I-131 whole body scan would be important to evaluate the correct staging and prognosis of thyroid carcinoma, and to follow-up patients.

• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1146-1151
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• 2023

Medullary thyroid carcinoma (MTC) is a rare malignancy that originates from the parafollicular cells of the thyroid gland. Hashimoto's thyroiditis (HT) is an autoimmune thyroid disease and is the most common cause of hypothyroidism. Previous studies have frequently discussed the association among HT, papillary thyroid carcinoma, and thyroid lymphoma. However, there have been few reports on the ultrasonographic findings of concomitant HT and MTC. In the present case, a heterogeneous hypoechoic background parenchymal echogenicity, with intraglandular echogenic strands, and increased vascularity were observed. A concurrent, ill-defined, parallel-oriented, heterogeneous hypoechoic mass with central microcalcifications was located at the left thyroid gland, consistent with reported US findings of medullary thyroid carcinoma except for an ill-defined margin in our case.

• Korean Journal of Head & Neck Oncology
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• v.12 no.1
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• pp.43-46
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• 1996

An unusual case of nodal metastases from thyroid neoplasm known as parapharyngeal space mass is likely to be overlooked. And identification of the primary lesion by excisional biopsy calls for a secondary operation. Therefore, it is important to be aware of the possible lymphatic spread of the thyroid neoplasm to the parapharyngeal space. In this case, completion thyroidectomy should be considered. Here, we present a case of thyroid papillary carcinoma masquerading as a parapharyngeal space tumor. The mass was removed by transcervical approach and pathologically diagnosed as a metastatic thyroid papillary carcinoma. Successful results were obtained after additional completion thyroidectomy.

• The Korean Journal of Cytopathology
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• v.14 no.1
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• pp.32-35
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• 2003

Multinucleated giant cells of osteoclast-like appearance can be seen in a type of anaplastic carcinoma of thyroid and only a few case reports for fine needle aspiration cytologic findings are found in the literatures. Recently, we experienced a case of anaplastic carcinoma of thyroid with many osteoclast-like giant cells in a 72-year-old woman. The cytologic features and immunohistochemical results are described with special emphasis on differential diagnosis.