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대한갑상선학회> International Journal of Thyroidology

International Journal of Thyroidology update

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수록정보
수록범위 : 1권1호(2008)~13권2호(2020) |수록논문 수 : 339
International Journal of Thyroidology
13권2호(2020년 11월) 수록논문
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1COVID-19 유행 시기의 갑상선질환 관리

저자 : 유원상 ( Won Sang Yoo ) , 정현경 ( Hyun-kyung Chung )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 65-71 (7 pages)

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The novel viral disease COVID-19 is spreading globally, causing countless infected individuals and deaths. There are active discussions and debates on how to manage patients with chronic illnesses in the COVID-19 pandemic era. Since thyroid diseases are chronic and associated with autoimmune diseases as well as high tumors, there is a need to assess the association between thyroid diseases and COVID-19. Recently, the American Thyroid Association and European Thyroid Association published a statement on thyroid disease management during the COVID-19 pandemic. Further, clinical data from COVID-19 patients also indicate that COVID-19 may affect thyroid functions. Therefore, we reviewed published literature on COVID-19 and thyroid diseases and discussed approaches to proper management of thyroid diseases during the COVID-19 pandemic.

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2갑상선유두암의 적절한 수술 범위

저자 : 김완욱 ( Wan Wook Kim )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 72-78 (7 pages)

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The goal of thyroid cancer surgery is the complete removal of the cancer, verification that patients receive appropriate treatment through accurate staging after surgery, minimization of local recurrence, and improvement of survival rate. However, maintaining the patient's functional outcome and quality of life by minimizing postoperative complications as well as having good oncological outcomes is also important. To determine the optimal surgical extent, appropriate diagnosis and evaluation should be made on age, gender, tumor size, multiplicity, extrathyroidal extension, lymph node/distant metastasis, and biologic aggressiveness. In the low-risk group, lobectomy is required, and experienced high-volume surgeons may consider ipsilateral prophylactic central lymph node dissection because of the acceptable risk of hypoparathyroidism. In the intermediate-risk group, personalized decision-making should be determined according to the patient's preferences and characteristics while also considering the pros and cons of lobectomy or total thyroidectomy. For the patient with high-risk factors, total thyroidectomy is considered. However, if a total thyroidectomy is not absolutely necessary and complications are expected, lobectomy could be a second option. If the patient has central lymph node metastasis, a therapeutic central lymph node dissection must be performed, and in the case of high-risk groups (T3/4 and N1b), ipsilateral prophylactic node dissection should be considered, and the contralateral parathyroid gland should be preserved. In the high-risk group (especially with massive ipsilateral lymph node metastasis or gross extrathyroidal involvement), the surgeon may consider bilateral central lymph node dissection if the ipsilateral parathyroid gland and the recurrent laryngeal nerve are well preserved, because of the risk of contralateral lymph node metastasis.

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3갑상선유두암에서 전이림프절에 대한 적절한 수술 범위

저자 : 권현근 ( Hyun-keun Kwon ) , 이병주 ( Byung-joo Lee )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 79-84 (6 pages)

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Papillary thyroid cancer (PTC) has a good prognosis, but the frequency of regional lymph node metastasis is reported to be up to 90%. In most patients with PTC, nodal metastasis occurs in a stepwise fashion, with metastasis beginning in the central cervical compartment, continuing to the ipsilateral cervical compartment. There are many controversies about the necessity of prophylactic central neck dissection (CND) and extent of therapeutic CND for lymph node metastasis. Ipsilateral CND with intraoperative frozen biopsy in PTC is a very sensitive and useful tool for the evaluation of nodal status in the central compartment. The right upper para-esophageal lymph nodes should be removed during dissection in patients with right paratracheal lymph node metastasis. Prophylactic lateral neck dissection (LND) is not recommended, and optimal extent of therapeutic LND is still controversial. Further studies on factors and clinical implications related to suprasternal lymph node metastasis are needed.

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4Recent Issues Related to Thyroid Disease in Pregnancy

저자 : Jae Hoon Chung

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 85-94 (10 pages)

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Maternal and fetal complications may occur because of pathologic or immunologic changes during pregnancy. The American Thyroid Association (ATA) suggests an optimal thyroid stimulating hormone (TSH) reference range of 0.50-4.00 mU/L in pregnant women. Based on Korean data, the same range may be applied to Korean pregnant women. According to the ATA guideline, levothyroxine therapy is recommended for thyroid peroxidase antibody (TPOAb)-positive women with a TSH greater than the pregnancy-specific reference range (approximately >4.0 mU/L in Korea) and TPOAb-negative women with a TSH >10.0 mU/L. The presence of TPOAb may be a sign of hypothyroidism due to damage to the thyroid. Because the titer of TPOAb decreases as gestation progresses, its measurement should be performed as early as possible during pregnancy. Although the mechanism is unknown, the association between thyroid autoimmunity and miscarriage/premature delivery is clear. Selenium may reduce the development of postpartum thyroiditis and permanent hypothyroidism; however, routine prescription of selenium is not recommended as it may increase the risk of type 2 diabetes. According to Korean nationwide data, birth defects in antithyroid drug (ATD)-exposed offspring in early pregnancy increased by 1.1 to 2.2% compared with non-exposed offspring. Avoidance of ATD in early pregnancy is the best option, otherwise, it is preferable to switch to propylthiouracil before pregnancy. When methimazole use is unavoidable in early pregnancy, it is recommended to use less than 5 mg per day.

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5Increasing Incidence of Thyroid Carcinoma: Risk Factors and Seeking Approaches for Primary Prevention

저자 : Valentina Drozd , Daniel I. Branovan , Christoph Reiners

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 95-110 (16 pages)

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Based on opinions published by many scientists about the increase in the incidence of thyroid cancer in many countries, this paper intends to identify research to be done on one hand with respect to reasons for this increase, the natural course of thyroid cancer and risk factors and - on the other hand - to support the clinician in primary prevention of thyroid cancer. Along with the traditionally discussed risk factors: ethnicity, heredity, sex effects/hormones, comorbidity, radiation exposure, diet (iodine), life-style (smoking), features of the natural environment, the effect of endocrine disrupters and in particular nitrates are also discussed. For the clinician, a simple approach for primary prevention of thyroid cancer is to refer the patient for a radiological examination applying ionizing radiation with exposure of the head and neck region only if the indication is justified according to the International Committee for Radiological Protection. In clinical practice, it is also important to take into account and minimize other risk factors: prevention of obesity and weight reduction, adequate treatment of various thyroid diseases, avoidance of excessive consumption of nitrates and other endocrine disruptors/ environmental pollutants. In case of a nuclear emergency, attention has to be paid for immediate withdrawal of contaminated food and drink as well as iodine thyroid blocking especially in vulnerable members of the population as children, pregnant or breastfeeding women. More research is also required to identify other reasons of the increasing incidence and predictors of aggressive vs indolent behavior of thyroid cancer to avoid unnecessary screening activity, overdiagnosis, and overtreatment.

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6Predictive Risk Factors for Recurrence or Metastasis in Papillary Thyroid Cancer

저자 : Wan Wook Kim , Jeeyeon Lee , Jin Hyang Jung , Ho Yong Park , Ji Yun Jeong , Ji-young Park , Ralph P. Tufano

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 111-117 (7 pages)

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Background and Objectives: This study investigated predictive risk factors for cervical nodal recurrence or metastasis in papillary thyroid carcinoma (PTC). Materials and Methods: From September 2014 to February 2015, a total of 321 PTC patients were enrolled retrospectively. Except for 154 N0 patients, the remaining 167 patients were divided into two groups as follows: Group I (n=140), central lymph node (LN) metastasis (pN1a); Group II (n=27), lateral LN metastasis (pN1b, n=23) or LN recurrence (n=4). The patients who had LN metastasis or recurrence underwent selective LN dissection or recurrent LN excision. Results: Central LN metastases were found in 44.0% (142/321) of patients. Two hundred thirty patients (71.7%) were classified as being at low-risk for LN disease, as evidenced by N0 or fewer than five micrometastases. The mean size of central metastatic LNs was 0.37±0.34 cm. A total of 76 patients (46.6%) presented with micrometastasis, and ten (3.1%) presented with extranodal extension (ENE). The multiple/bilateral cancer, Extrathyroidal extension, size of metastatic LN, ENE, high risk LN disease (>5, macrometastasis, >3.0 cm) and high thyroglobulin were significant risk factors in predicting LN recurrence or lateral LN metastasis (p<0.05) in univariate analysis. Patients with ENE were 10.3 times more at risk for recurrence or metastasis than patients without ENE. Conclusion: We consider the ENE was the most potent risk factors for LN recurrence or lateral LN metastasis in PTC.

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7Changes of Nodular Size and Its Risk Factors in Iodine-Sufficient Area: a Retrospective Cohort Analysis of 7753 Thyroid Nodules

저자 : Hwa Young Ahn , Kyung Won Kim , Hoon Sung Choi , Jae Hoon Moon , Ka Hee Yi , Min Kyung Hyun , Min Joo Kang , Jung Im Shim , Ja Youn Lee , Do Joon Park , Young Joo Park

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 118-127 (10 pages)

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Background and Objectives: Iodine is known to be an important factor in the occurrence of goiter, and South Korea is a region with sufficient iodine supplementation. In this regard, we checked the size change of thyroid nodules found by health check-up in Koreans and examined which risk factors influence the size change. Materials and Methods: A total 7753 subjects who underwent thyroid sonography two or more times were included. We defined that there was a change in the size of the nodule when the difference in diameter identified in the last ultrasound was more than 3 mm. Results: Thyroid nodules were decreased in 895 subjects (11.5%) and increased in 1041 subjects (13.5%). The rate of increased nodule was on an increasing trend according to the duration (annual percent change 2.6%, p<0.001). In contrast, the rate of decreased nodule was unchanged. Predictive factors related to decrease of the nodule size were young age, male sex, larger initial nodule size and thyroiditis. Similarly, young age, larger initial nodule size and diffuse parenchymal abnormality were significant predictive factors for increased nodules. However, diffuse parenchymal abnormality was not a predictive factor when we analyzed only thyroid nodules larger than 1 cm. Conclusion: In our study, 11.5-13.5% of benign thyroid nodules were increased or decreased during median 27 months of follow-up in iodine sufficient condition. Young age, larger initial size and diffuse parenchymal abnormality were common predictive factor affecting both the increase and decrease of thyroid nodules.

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8Ultrasound-Guided Percutaneous Ethanol Ablation for the Management of Recurrent Thyroid Cancer: Evaluation of Efficacy and Impact on Disease Course

저자 : Santiago Tofé , Iñaki Argüelles , Guillermo Serra , Honorato García , Antonia Barcelo , Vicente Pereg1

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 128-141 (14 pages)

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Background and Objectives: Neck recurrences of thyroid cancer are frequently detected in routine ultrasound (US) follow-up. Broad management of these lesions may include active surveillance, surgery or local percutaneous techniques, but for the latter, little is known about impact on long-term follow-up and need of subsequent radioactive iodine (RAI) therapy. Materials and Methods: 42 patients underwent US-guided ethanol ablation (EA) over 71 thyroid bed or lymph node confirmed recurrences. All volume reduction >50%, absence of power Doppler signal and fine needle aspiration (FNA) washout thyroglobulin (Tg) value <1 ng/mL should be present to consider a complete ablation. Patients with TNM stage I-II, ≤2 lesions and/or baseline plasma TSH-suppressed Tg level <0.2 ng/mL did not undergo post-EA RAI therapy. Post-EA plasma Tg values were compared to baseline in patients with and without subsequent RAI therapy. Results: 62 lesions (87.32%) achieved a complete ablation after a mean follow-up of 40.5 months (range, 12-73). Four treated lesions (5.63%) recurred (3/39 and 1/32 in patients with and without subsequent RAI therapy), and 7 patients (16.66%) developed new recurrences throughout follow-up (5/19 and 2/23 with and without RAI therapy). Both plasma TSH-suppressed and TSH-stimulated Tg levels descended after EA in both groups, and 17/38 (44.73%) patients achieved a TSH-suppressed Tg <0.2 ng/mL, with no differences between both groups of patients. All EA procedures were conducted safely without serious or persistent side effects. Conclusion: Successful EA were achieved safely in 87.32% of patients with recurrent thyroid cancer, with a positive effect on systemic disease as reflected by plasma post-EA Tg levels. A subset of patients with TNM stage III, ≤2 lesions and/or low pre-EA plasma Tg levels may not need subsequent RAI therapy after successful ablation. Overall, EA is an effective and balanced therapy for selected patients with neck recurrent thyroid cancer as an alternative to surgery.

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9Annual Neck Ultrasonography Surveillance between 3 to 12 Years after Thyroid Lobectomy for Papillary Thyroid Microcarcinoma

저자 : Jin Gu Kang , Jung Eun Choi , Soo Jung Lee , Su Hwan Kang

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 142-149 (8 pages)

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Background and Objectives: In South Korea, neck ultrasonography (US) has been used widely at 1- or 2-year intervals to detect recurrence after thyroidectomy. The aim of this study is to assess the prevalence and pattern of recurrence and to establish a proper frequency of follow-up neck US after thyroid lobectomy for papillary thyroid microcarcinoma (PTMC). Materials and Methods: We retrospectively reviewed 262 consecutive patients who had undergone thyroid lobectomy for PTMC from January 2005 to October 2009. They were divided into two groups based on the presence of recurrence (240 patients in group 1 and 22 patients in group 2). The comparison between the two groups involved clinical and pathological characteristics. Results: Recurrences were found in 22 (8.4%) of 262 patients with 132.5 months follow-up (range, 120-180 months). There was a significant difference in the mean number of follow-up neck US after 5 years postoperatively, shortened interval, total number of follow-up neck US (p=0.002, p<0.001, p<0.001). All recurrences were found between 2-3 to 11-12 years. Recurrences after 5 years were found in 16 (72.7%) of 22 patients. Conclusion: Recurrence after thyroid lobectomy for PTMC occurred with various times during follow up. The minimum frequency of follow-up neck US was not enough for detecting tumor recurrence, especially after 5 years postoperatively. Our results suggest that annual neck US may be appropriate between 3 to 12 years after thyroid lobectomy for PTMC.

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10Pediatric Quality of Life in Congenital Hypothyroidism: an Indonesian Study

저자 : Nur Rochmah , Muhammad Faizi , Carrina Dewanti , Ahmad Suryawan

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 13권 2호 발행 연도 : 2020 페이지 : pp. 150-154 (5 pages)

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Background and Objectives: Thyroxine is important for brain development. Improper hypothyroid treatment may lead to cognitive and motor impairment, thereby affecting the quality of life. We analyzed the correlation between age at first treatment, length of treatment, initial levothyroxine (LT4) dose, and serum levels of free thyroxine (fT4) and thyroid stimulating hormone (TSH) and pediatric quality of life in patients with congenital hypothyroidism (CH). Materials and Methods: This research was a cross-sectional study of 41 children with CH who consumed LT4 for at least 3 months during March 2019-December 2019. The quality of life was assessed from parents' reports using the Pediatric Quality of Life Inventory (PedsQL) generic scale. Spearman correlation analysis was carried out, and statistical significance was set at p<0.05. Results: A total of 17 of the 41 children were girls. The mean PedsQL scores in physical and psychosocial functioning were 78.12 (68.75-100) and 233.30 (215-251.67), respectively. Age at first treatment was correlated with physical functioning (r=-0.501, p<0.05) and psychosocial functioning (r=-0.440, p<0.05). The initial LT4 dose was negatively correlated with physical functioning (r=-0.568, p<0.05) and psychosocial functioning (r=-0.482, p<0.05). The length of treatment showed a positive correlation with physical functioning (r=0.776, p<0.05) and psychosocial functioning (r= -0.852, p<0.05). However, the serum fT4 and TSH levels were not correlated with quality of life in children with CH (p>0.05). Conclusion: Age at first treatment, initial dose of LT4, and length of treatment were correlated with quality of life in children with CH.

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