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대한갑상선학회> International Journal of Thyroidology> 제6기 국민건강영양조사 자료를 이용한 요중 요오드 농도와 갑상선 과산화효소항체의 분석

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제6기 국민건강영양조사 자료를 이용한 요중 요오드 농도와 갑상선 과산화효소항체의 분석

Urinary Iodine Concentration and Thyroid Peroxidase Antibodies in the Korean Population Using Korea National Health and Nutrition Examination Survey VI

장명철 ( Myung-chul Chang )
  • : 대한갑상선학회
  • : International Journal of Thyroidology 13권2호
  • : 연속간행물
  • : 2020년 11월
  • : 155-164(10pages)
International Journal of Thyroidology

DOI


목차

서 론
대상 및 방법
결 과
고 찰
Conflicts of Interest
Orcid
References

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Background and Objectives: This study was planned to investigate the relationship between iodine intake and thyroid peroxidase antibody in Korean population. Materials and Methods: We used the data of the 6th Korea National Health and Nutrition Examination Survey from 2013 to 2015. A total of 6564 subjects who had the data of thyroid function test were included. We analyzed urinary iodine concentration and thyroid peroxidase antibody using the complex sample method. Univariate and multivariate analysis were performed according to clinical factors and thyroid function tests. Results: In the multivariate analysis, the thyroid peroxidase antibody positivity was not related to urinary iodine concentration in the total group (p=0.102), male group (p=0.245) and female group (p=0.098). The urinary iodine concentration was associated with thyroid stimulating hormone (TSH) (p=0.001) and free T4 (p=0.001) but not associated with thyroid peroxidase antibody (p=0.218). When high TSH group was divided into the positive and negative thyroid peroxidase antibody, high TSH group with negative thyroid peroxidase antibody increased according to increasing urinary iodine concentration (p<0.001). But there was no difference in the high TSH group with positive thyroid peroxidase antibody (p=0.826). Conclusion: This study did not show a statistically significant relationship between urinary iodine concentration and thyroid peroxidase antibody. As urinary iodine concentration increased, thyroid function was decreased only in the negative thyroid peroxidase antibody group. This confirmed that the increased urinary iodine concentration caused hypothyroidism which was not associated with thyroid peroxidase antibody.

UCI(KEPA)

I410-ECN-0102-2021-000-001238064

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • :
  • : 반년간
  • : 2384-3799
  • : 2466-1899
  • : 학술지
  • : 연속간행물
  • : 2008-2021
  • : 351


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1갑상선 수술의 수술 중 신경모니터링의 적용에 관한 최신지견

저자 : 유지영 ( Ji Young You ) , 김훈엽 ( Hoon Yub Kim )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 1-5 (5 pages)

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Intraoperative neuromonitoring is a well-established method used to prevent intraoperative nerve damage, and many studies have been performed in thyroid surgery. We introduced the basic concept and practical application of intraoperative neuromonitoring, as well as its standardized techniques and detailed contents. In addition, the contents of this still yet relatively unknown field, such as its application in transoral robotic thyroidectomy and its application to the external branches of the superior laryngeal nerve, were summarized by referring to many previous studies.

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2Clinical Outcome of Parotid Gland Massage for Preventing Parotid Gland Dysfunction in Patients Treated with Radioiodine Therapy for Differentiated Thyroid Cancer: a Prospective Longitudinal Follow-Up Study

저자 : Seung Hyun Son , Chae Moon Hong , Shin Young Jeong , Jaetae Lee , Byeong-cheol Ahn

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 6-17 (12 pages)

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Background and Objectives: The aim of this study was to determine the clinical effectiveness of parotid gland (PG) massage for the prevention of PG dysfunction after administration of radioiodine (I-131) therapy for treatment of differentiated thyroid cancer (DTC). Materials and Methods: One hundred patients with DTC with planned high-dose I-131 therapy were enrolled in the clinical trial and randomized into two groups (massage and non-massage group). Serum amylase values were obtained before and 24 h after I-131 therapy, and salivary gland scintigraphy (SGS) were taken before and at eight months after the I-131 therapy. Additional SGS (addSGS) were taken when the patients complained symptoms related to salivary gland dysfunction. Questionnaire surveys were performed before and until two years after I-131 therapy. Results: Ninety-five of 100 patients finished the study protocol. Changes in survey scores tended to be higher in the non-massage group. The non-massage group had more severe symptoms related to salivary gland dysfunction. Among 32 patients who underwent addSGS, 27 had normal 8-month SGS. Of these 27 patients, 18 (66.7%) had salivary gland dysfunction on the addSGS. Amylase values were significantly increased in patients with normal 8-month SGS but abnormal addSGS, as compared to patients who were normal on both 8-month SGS and addSGS (p=0.046). Amylase difference values were a significant predictor of abnormal addSGS (p=0.002). Conclusion: PG massage reduced symptoms related to salivary gland dysfunction. The PG massage may be helpful in preventing damage to salivary glands caused by I-131 therapy.

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3Clinical Outcome of Fine Needle Aspiration Cytology and Washout Thyroglobulin in Suspicious Lymph Nodes in Differentiated Thyroid Carcinoma: Discordant Results in Real-World Practice

저자 : Jeongmin Lee , Hye Lim Park , Kwanhoon Jo , Min-hee Kim , Ja Seong Bae , Sohee Lee , Chan Kwon Jung , So-lyung Jung , Dong-jun Lim

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 18-27 (10 pages)

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Background and Objectives: Fine needle aspiration cytology (FNAC) combined with washout thyroglobulin (Tg) measurement is the gold standard for the evaluation of metastatic lymph nodes (LNs) in thyroid cancer. However, few studies have assessed the clinical outcomes of discordant results between FNAC and washout Tg based on surgery status and follow-up imaging in real-world practice. Materials and Methods: A total of 707 LNs in 512 patients who underwent FNAC and washout Tg measurements from 2015 to 2017 were analyzed. The final LN outcomes were confirmed through postoperative histology, or through metastatic FNAC findings combined with high washout Tg level, follow-up imaging studies, or repeat FNA, if LNs were not dissected. Results: The cut-off values of washout Tg for indicating LN metastasis in preoperative and postoperative LNs were 9.6 ng/mL and 2.1 ng/mL. The diagnostic accuracy was improved by applying washout Tg according to surgery status and the results of discordant rate was reduced, Discordant between results of FNAC with washout Tg and final outcome were 9.2% (27/295) of preoperative LNs and 8.7% (36/412) of postoperative LNs. Due to inconclusive results, unnecessary neck dissection can occur in 13.9% (36/259 dissected cases). Conclusion: To improve diagnostic accuracy, cut-off values of washout Tg should be applied depending on surgery status. New biomarkers in washout fluid is necessary to resolve discordant findings.

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4Clinicopathological Features of Patients Diagnosed with Both Primary Thyroid Cancer and Primary Renal Cell Cancer and Its Comparison with Patients with Thyroid Cancer or Renal Cell Cancer Alone

저자 : Jun Park , Young Nam Kim , Hyunsoo Ryoo , Hyunju Park , So Young Park , Tae Hyuk Kim , Jae Hoon Chung , Seong Il Seo , Sun Wook Kim

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 28-36 (9 pages)

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Background and Objectives: Thyroid cancer (TC) and renal cell carcinoma (RCC) display more frequent co-occurrence than would be expected by chance. We investigated clinicopathological features of patients with both primary TC and primary RCC (TC/RCC) group to facilitate a greater understanding of the relationship between two cancers. Materials and Methods: A total of 53 patients who diagnosed with TC/RCC were enrolled. 13,663 TC-alone and 3279 RCC-alone patients who had undergone surgery at Samsung Medical Center between 1994 and 2014 were included as control groups. The clinicopathological characteristics of these patients were retrospectively reviewed. Results: The median age at the time of TC or RCC diagnosis was 54 years in TC/RCC group and the RCC-alone group, while the patients in TC-alone group were significantly younger (47 years). The TC/RCC group showed a nearly equal sex prevalence (49% male), significantly different than the results of the TC-alone group (80% female) and RCC-alone group (71% male). A higher grade of pathologic stage (56.6% in stage 3) and greater number of patients with multifocality of thyroid tumors (45 vs. 32%), and more family history of cancer (32 vs. 0.4%) were revealed in TC/RCC group than in TC-alone group. In addition, 15.1% of patients in TC/RCC group presented with additional primary cancers such as prostate, colon, stomach, breast, and lung cancers. Conclusion: Patients in the TC/RCC group have a high rate of cancer family history, multifocality of thyroid tumors, and additional cancers. To understand this unique subset group, additional studies for environmental and genetic factors would be helpful for earlier diagnosis of combined cancers.

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5Branchial Cleft Cyst Mimicking Malignant Thyroid Neoplasm Concurrent with Medullary and Papillary Thyroid Carcinoma: a Case Report

저자 : Wook Yi , Bo Hyun Kim , Byung Joo Lee , Kyungbin Kim

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 37-41 (5 pages)

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Branchial cleft cysts are the most common lateral neck mass, and usually have well-delineated cystic structures under ultrasonography. Ultrasonography and fine needle aspiration cytology is very helpful during preoperative diagnosis. However, these cysts may occur in unusual locations and have a sonographic morphology similar to malignant thyroid neoplasm. A 61-year-old woman presented with thyroid nodules, and ultrasonography revealed a 0.8-cm, hypoechoic, solid nodule with microcalcifications in the right lobe of thyroid in the lower portion. Postoperative histopathological examination revealed the 0.8-cm hypoechoic nodule to be a branchial cleft cyst. In addition, concurrent medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) were found. Herein, we present a rare case of branchial cleft cyst mimicking malignant thyroid neoplasm concurrent with medullary and PTC.

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6A Case of Hyperparathyroidism Caused by Intrathyroidal Parathyroid Adenoma

저자 : Ki Ju Cho , Sang-wook Park , Seongjun Won , Jin Pyeong Kim , Jung Je Park

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 42-45 (4 pages)

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Hyperparathyroidism is a common endocrine disorder, but intrathyroidal parathyroid adenoma is extremely rare. We report a on a case of hyperparathyroidism caused by intrathyroidal parathyroid adenoma. This case is important in that it affects an effective test for the diagnosis of intrathyroidal parathyroid adenoma, and shows the decision of the treatment process and the results.

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7Spurious Thyroid Function Test Results due to Biotin Interference: a Report of Three Cases and a Literature Review

저자 : Ji Yong Park , Wonsuk Choi , Jee Hee Yoon , Ho-cheol Kang

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 46-49 (4 pages)

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Biotin (vitamin B7) is a water-soluble vitamin used as a co-enzyme for carboxylases essential for human metabolism. The high affinity to streptavidin makes biotin an important substance in immunoassays. Excessive biotin intake due to over-the counter supplements has become problematic because of the effects on laboratory test results. There have been no reports of biotin-induced thyroid immunoassay interference in Korea. We report three patients with papillary thyroid cancer who showed false thyrotoxicosis on follow-up laboratory examinations with a literature review. The patients' medical history should be thoroughly questioned and patients should be informed to curtail consuming biotin before laboratory tests to avoid assay interference. Non-biotinylated assays can be considered if it is impossible to withhold the supplements. These methods will prevent physicians from making incorrect decisions that could result in an inappropriate treatment for their patients.

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8Painful Hashimoto Thyroiditis in a 7-Year-Old Girl: Differential Diagnosis and Medical Treatment

저자 : Gihong Park , Kyungchul Song , Hyun Joo Shin , Hyun Wook Chae

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 50-54 (5 pages)

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Painful Hashimoto thyroiditis (HT) is a rare pediatric condition. Because of the rarity of painful HT, it can be misdiagnosed as other thyroid diseases, and there is limited evidence regarding its clinical course and treatment. A 7-year-old girl presented to the emergency room with neck pain. A physical examination revealed diffusely enlarged thyroid gland with firm consistency and without tenderness. Her serum free thyroxine level was decreased and levels of thyroid-stimulating hormone, thyroglobulin antibody, and thyroid-stimulating antibody were elevated. The ultrasonography revealed a diffusely enlarged thyroid gland with homogeneously hypoechoic parenchyma and lobulated contours. She was diagnosed with painful HT based on the clinical presentations, laboratory tests, and ultrasonography findings, and was treated with a steroid, levothyroxine, and nonsteroidal anti-inflammatory drugs, after which her clinical symptoms improved dramatically. We should consider the possibility of painful HT in children with neck pain; HT could be treated with medical treatment.

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9NIRAF (Near-Infrared Autofluorescence)를 이용하여 갑상선 피막 내의 부갑상선을 찾아 자가이식하여 보존한 두 예

저자 : 김창회 ( Chang Hoi Kim ) , 서윤수 ( Yoon Su Seo ) , 김성원 ( Sung Won Kim ) , 이강대 ( Kang Dae Lee )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 55-59 (5 pages)

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For safe thyroidectomy, preservation of the parathyroid gland is mandatory. However, until recently, there has been no reliable method of identifying the parathyroid glands. Thus, the identification of the parathyroid gland has mainly depended on the surgeon's personal experience. To overcome this limitation, near infrared autofluorescence (NIRAF) imaging technique has been introduced. Many reports support the claim that NIRAF imaging can help surgeons identify the parathyroid gland. However, there have been no reports on the feasibility of NIRAF imaging in detecting the intrathyroidal parathyroid glands that cannot be seen by the naked eye. Recently, we experienced two cases in which intrathyroidal parathyroid glands were identified and auto-transplanted with the use of NIRAF. We would like to share this experience and hope this paper helps thyroid surgeons identify the parathyroid gland more easily which is always a matter of concern.

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10갑상선 결핵과 동반된 유두 갑상선 암종 환자 1예

저자 : 임성진 ( Sung Jin Lim ) , 한문수 ( Mun Soo Han ) , 이민규 ( Min Kyu Lee ) , 박동현 ( Dong Heun Park ) , 권순영 ( Soon Young Kwon ) , 오경호 ( Kyoung Ho Oh )

발행기관 : 대한갑상선학회 간행물 : International Journal of Thyroidology 14권 1호 발행 연도 : 2021 페이지 : pp. 60-62 (3 pages)

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Thyroid tuberculosis with papillary thyroid carcinoma is very rare. The current study shows the case of a 67-year-old female who was admitted to Ansan Hospital of Korea University, with her thyroid nodules showing signs of malignancy under ultrasonography. A histopathological examination proved the coexistence of papillary thyroid carcinoma (PTC) and thyroid tuberculosis (TB). A total thyroidectomy and excision of the enlarged left neck level II lymph node were performed. This report presents a rare case of coexistence of PTC and thyroid TB. Further investigation is needed to evaluate the possible role of PTC in thyroid mycobacterial infection.

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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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