• Korean Journal of Head & Neck Oncology
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• v.28 no.2
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• pp.143-145
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• 2012

Follicular thyroid cancer(FTC) accounts for about 10-15% of thyroid cancer. Distant metastasis is common, usually to lung, bone and brain. 71-years-old man visited neurosurgery outpatient department. He complained of recent 6kg weight loss, left upper extremity pain with weakness and back pain. The radiologic findings showed multiple bone metastasis including thoracic spine and left scapular resulting from FTC. There was a probable brain metastatic lesion on right temporal fossa. The core biopsy of thyroid and thoracic spine(T11) confirmed metastatic follicular carcinoma. Radioactive iodine therapy and radiotherapy was done following total thyroidectomy. We report a unique case of multiple bone metastasis from follicular carcinoma of thyroid with literature review.

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.253-259
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• 1998

The increasing risk of subsequent malignancy after treatment of malignant lymphoma is well known, which is mainly due to longer survival of these patients. Radiotherapy at an early stage of Hodgkin's disease or non-Hodgkin's lymphoma is accepted to be associated with future occurrence of secondary thyroid cancer. Nevertheless, the synchronous presentation of these malignancies is extremely rare. Well differentiated thyroid cancer, a slow-growing tumor that responds to therapy with surgery and radioactive iodine, is associated with prolonged survival. therefore, it is important to make this diagnosis in patients who show evidence of malignant lymphoma. Furthermore, appropriate treatment must be considered for thyroid cancer to improve the prognosis of these patients. We herein reported 4 cases of synchronous thyroid cancer and malignant lymphoma in patients who had not previously recieved radiotherapy or chemotherapy.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.3
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• pp.1135-1138
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• 2015

Background: The objective of this study was to investigate the MSCT characteristics of PTL in order to enhance the awareness of this uncommon entity among both clinicians and radiologists. Materials and Methods: The clinicopathological data and MSCT images of 27 patients with PTL were retrospectively reviewed. The MSCT appearances were classified into three types: type 1, solitary nodule surrounded by normal thyroid tissue; type 2, multiple nodules in the thyroid, and type 3, enlarged thyroid glands with a reduced attenuation with or without peripheral thin hyperattenuating thyroid tissue. Results: The patients were enrolled in the study with a mean age of 68 years (range, 51-86years) and compression symptoms or enlarged cervical lymph nodes at diagnosis. Hashimoto's thyroiditis was in 20 patients. All patients had non-Hodgkin lymphoma of B-cell in origin, including 22 cases of diffuse large B-cell lymphoma (DLBCL) and 5 of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). For MSCT appearance, type 1 pattern was observed in 2 patients, type 2 in 8, and seventeen type 3 in 17. The lesions occurred in more than one lobe with a mean maximal transverse diameter of 6.9 cm and an ill-defined margin. Most tumors showed a homogeneous attenuation equal to that of surrounding muscles before contrast and obvious enhancement after contrast. Cervical lymph node involvement and invasion of the trahea and (or) esophagus were mainly observed in patients with DLBCL. Conclusions: PTL should be clinically considered in elder patients presenting with a history of Hashimoto's thyroiditis and cervical lymphadenopathy. The MSCT characteristics of PTL includes a mass diffusely affecting more than one thyroid lobe, isointense to muscle and obvious enhancement before and after contrast. DLBCL, the most common histological subtype of PTL, is associated with a higher invasive tendency.

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.228-235
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• 1998

Objectives: Papillary microcarcinoma of the thyroid was evaluated as to the effectiveness of diagnostic modalities, lymphatic spread pattern, and therapeutic decision according to tumor size. Material and Methods: We retrospectively analyzed a clinicopathologic findings of 72 papillary microcarcinoma patients who were treated at the over 11 years between 1985 and 1995. The authors divided papillary microcarcinoma of the thyroid into two subgroups according to tumor size: $0{\leqq}5mm$ and $5<0{\leqq}10mm$. An analysis including age and gender distribution, diagnostic tools(thyroid sonogram, thyroid scan, thyroid function test, fine needle aspiration cytology, frozen section), pathological examination of lymphnode, and surgical procedures was carried out in each subgroups. Results: The carcinoma of smaller than 5mm were found in 32 patients, and of 6 -10mm were in 40 patients. The average age of patients was 45years and all of them were female. Cold nodules on thyroid scan were noticed in 53 patientss and normal findings were in 15 patients. Suspicious malignant lesions(fine calcification, solid mass, irregular margin) on thyroid sonography were detected in 23 patients and the sonography was more useful in detecting $0{\leqq}5mm$ small sized lesions than other diagnostic methods. FNAC were performed in 17 patients, and 7 patients were diagnosed as having thyroid papillary cancer. But diagnotic rate in $0{\leqq}5mm$ small sized lesions was very low(one of eights).Frozen section were performed in all patients, among these 15 patients were diagnosed as being benign diseases and false negative rates were higher in $0{\leqq}5mm$ small sized lesions than in $5<0{\leqq}10mm$ sized lesions(p-value<0.006). Only thyroidectomies were performed in 24 patients and thyroidectomy with node dissections in 48 patients. The lymphnode metastatic rates were much higher in multifocal lesions(61.5%) than in single lesion. The incidence of cervical lymphnode metastasis was 19.4% in $0{\leqq}5mm$ sized lesions and 47.9% in $5<0{\leqq}10mm$ sized lesions. Postoperative management were performed with TSH suppression therapy(T4, synthroid) in all patients and RI therapy in 29 patients. Conclusion: On the basis of our study, improved preoperative diagnostic tools for papillary microcarcinoma of the thyroid was helpful in the choice of surgical treatment. As a result of techninological progress(ultrasonography, FNAC), the pencentage of the discovery of papillary microcarcinoma has been increased. The thyroid ultrasonography was useful in detecting small sized lesions($0{\leqq}5mm$), but FNAC may not be beneficial in detecting small sized lesions($0{\leqq}5mm$). In the surgical procedure, thyroid lobectomy alone should be avoided because of the high rate of bilaterality and multifocality.

• The Korean Journal of Nuclear Medicine
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• v.29 no.4
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• pp.451-459
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• 1995

Thirty-eight patients with metastatic well-differentiated thyroid carcinoma treated with 200mCi $^{131}I$ were studied. There were false negative serum thyroglobulin values during TSH suppression or at anti-thyroglobulin antibody(+) and discrepancies between findings of whole body scan and serum thyroglobulin level. After one to five cycles of 200mCi $^{131}I$ therapy, complete remission and partial remission were achieved at 5.3% and 57.9%, respectively. We concluded that all of serum thyroglobulin, TSH, anti-thyroglobulin antibody, $^{131}I$ or $^{123}I$ whole body scan were necessary in follow up of metastatic well-differentiated thyroid carcinoma. Also, if there was no response after repetitive 200mCi $^{131}I$ therapy, higher doses of $^{131}I$ therapy should be considered.

• The Korean Journal of Nuclear Medicine
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• v.16 no.2
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• pp.1-24
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• 1982

Several recent advances in our knowledge of thyroid physiology have broad application to the diagnosis and management of thyroid disorders. For in the thyroid, more than other endocrine organs, pathophysiology can be translated directly into the diagnosis and management of thyroid disease. Graves' disease is a syndrome including goiter with hyperthyroidism, exophthalmos and dermopathy. The pathogenesis of Graves' disease is not yet clearly identified, but various autoantibodies to the thyroid gland and immunopathologic studies indicate that autoimmune processes are involved in the pathogenesis of the disease. The diagnosis and management of Graves' disease are largely dependent on radionuclide techniques as radioimmunoassay, radioactive iodine therapy and so on. Several laboratory tests are also developed to determine the remission of this disase including TRH stimulation test, $T_3$ suppression test and detection of thyroid stimulating immunoglobulins. Autoimmune thyroiditis is almost certainly a primary immunologic disease and the incidence tends to increase recently, mainly due to the application of biopsy technique in thyroid diseases. Thyroid nodules have been a great challenge to physicians because of the possibility of malignancy. But recently, cytologic examination of thyroid aspirate provides a very simple and also reliable diagnostic method in patients with thyroid nodules. In 163 patients with thyroid nodules, only 19.3% was revealed to be malignant. Therefore cytologic examination of thyroid aspirate and thyroid biopsy should be included in the diagnosis of nodular patients prior to surgical intervention. In this paper, a comprehensive review is presented on the pathogenesis, clinical features, laboratory findings and therapeutic modalities of various thyroid diseases on the basis of over 80 researches performed during the past 20 years at radioisotope clinic, Seoul National University Hospital.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.3
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• pp.218-225
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• 2007

Purpose: Postoperative thyroid remnant radioablation therapy is necessary to reduce the recurrence and mortality rates as well as to prepare the patients for a proper long term surveillance of well-differentiated thyroid cancers. The radiation safety rules of the government require the patient to be isolated in a hospital if the expected radiation exposure to the family members would be greater than 5 mSv (500 mRem). The purpose was to measure the radiation received by the family members of patients who received large doses of NaI-131. Material and Methods: We have administered 12 therapy doses ranging from 3.70-5.55 GBq (100 to 150 mCi) to 11 patients, and released them immediately if they met the radiation safety criteria. Informed consent was obtained from the subjects prior to the therapy, and each of them agreed to follow written radiation safety instructions. TLD badges were used to measure the radiation dose received by the family members and the room adjacent to the patient's bed room during the first 72 hours. Results: The average dose received by the family members who spent the most time in the closest distance with the patients was 0.04 mSv with a range of 0.01-0.17 mSv. Even the highest dose was only about 3% of the limit set by the government. The average radiation dose to the outer wall of the patient's room was 0.15 mSv. Conclusion: It is concluded that I-131 ablation therapy can be administered to outpatients safely to thyroid cancer patients who meet the established radiation safety criteria and follow the instructions.

• Clinical and Experimental Pediatrics
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• v.63 no.2
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• pp.52-55
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• 2020

Background: Immunomodulatory properties of interferon (IFN) have been documented. It may induce autoimmune diseases such as autoimmune thyroiditis with hypo- or hyperthyroidism. In addition, it may impair thyroid hormone synthesis through affecting iodide organification in thyroid gland. Purpose: The aim of this study was to describe thyroid function tests disturbances in children with chronic hepatitis C (CHC) receiving pegylated interferon-alpha (PEG IFN-α) plus ribavirin. Methods: Fifty children with CHC virus infection who received combined pegylated interferon-alpha with ribavirin were selected. Other 50 apparently healthy children of matched age and sex (considered as control group) were selected. All children (100) were subject to liver function tests, virological studies, and follow-up of thyroid function test during and after the treatment course. Results: Our study showed that 28% of children received combined PEG IFN-α plus ribavirin showed subclinical hypothyroidism. After 24 weeks treatment with combined therapy of IFN plus ribavirin, the mean level of thyroid stimulating hormone (TSH) was 3.23±88 mU/mL, while TSH was 1.16±0.77 mU/mL before starting treatment. On the other hand, mean TSH was 1.09±0.92 mU/mL in normal control group. Conclusion: This study revealed an association between subclinical thyroid dysfunction and treatment with IFN-alpha and ribavirin in children. Further studies on larger number of patients and longer follow-up duration are recommended for further confirmation.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.12
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• pp.4935-4944
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• 2010

The purpose of this study was to investigate the perceived difficulties during both pre-treatment period and admission period for radioactive iodine therapy (RAIT), the level of information about RAIT provided by medical staffs and the satisfaction of RAIT process in thyroid cancer patients receiving RAIT. Participants were 165 thyroid cancer patients, who had total thyroidectomy and had been offered RAIT. The data were collected using structured questionnaire and open-ended questions and analyzed by descriptive statistics and content analysis. The most frequent perceived difficulties of RAIT was associated with thyroid specific symptoms during both pre-RAIT period and RAIT admission period(38.2% vs 43.0%). The rating of RAIT information provided by medical staffs was evaluated as over moderate level(mean $3.63{\pm}0.80$). The RAIT process satisfaction was investigated as moderate level(mean $6.43{\pm}2.21$). the satisfaction of RAIT was the highest in medical attention and coping procedure (mean $7.64{\pm}2.37$) however it was the lowest in adequacy of RAIT information(mean $5.67{\pm}2.78$). Thus the nursing intervention program for thyroid cancer patient undergoing RAIT should be developed to support needs of thyroid cancer patients related to thyroid specific symptoms and to improve patients' understanding about RAIT procedure so that patients have competence to participate in therapeutic activities efficiently.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.4
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• pp.442-446
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• 1995

Thyroid carcinomas are usually classified as papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma and anaplastic thyroid carcinoma. Among the thyroid carcinomas, the incidence of medullary and anaplastic thyroid carcinoma is low, but the rate of lymph node & distant metastasis from them are more common compared to other types. Follicular thyroid carcinoma has a low rate of lymph node metastasis as 10% and has a high occurrence of hematogenous metastasis to lung, bone, brain and liver. Papillary thyroid carcinoma accounts for $60{\sim}70%$ of whole thyroid carcinomas and the cervical lymph node metastasis is $21{\sim}81%$ including micrometastasis, but the distant metastasis is rare. In the case of bone metastasis, follicular type reveals most frequent, and the rate is about 5%, and more likely to be found on vertebra, pelvis, ribs, femur, and skull. The clinical symptoms of bone metastasis are pain, swelling, pathological fracture and radiologically osteolytic lesions can be observed. But distant metastasis of papillary thyroid carcinoma is very rare and especially, bone metastasis has hardly been reported. The treatment modalities of metastatic thyroid carcinoma to mandible are known as follows : thyroidectomy to treat primary site, resection of the affected site of mandible, external beam radiotherapy and radioiodine therapy etc.