Endocrinology and Metabolism

Original Articles

Thyroid
Lack of Associations between Body Mass Index and Clinical Outcomes in Patients with Papillary Thyroid Carcinoma: Hyemi Kwon, Mijin Kim, Yun Mi Choi, Eun Kyung Jang, Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Young Kee Shong, Dong Eun Song, Jung Hwan Baek, Suck Joon Hong, Won Bae Kim; Endocrinol Metab. 2015;30(3):305-311. Published online November 26, 2014; DOI: https://doi.org/10.3803/EnM.2015.30.3.305

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Background

Obesity is associated with aggressive pathological features and poor clinical outcomes in breast and prostate cancers. In papillary thyroid carcinoma (PTC), these relationships remain still controversial. This study aimed to evaluate the associations between body mass index (BMI) and the clinical outcomes of patients with PTC.

Methods

This retrospective study included 1,189 patients who underwent total thyroidectomy for PTCs equal to or larger than 1 cm in size. Clinical outcomes were evaluated and compared based on the BMI quartiles.

Results

There were no significant associations between BMI quartiles and primary tumor size, extrathyroidal invasion, cervical lymph node metastasis, or distant metastasis. However, an increase in mean age was associated with an increased BMI (P for trend <0.001). Multifocality and advanced tumor-node-metastasis (TNM) stage (stage III or IV) were significantly associated with increases of BMI (P for trend 0.02 and <0.001, respectively). However, these associations of multifocality and advanced TNM stage with BMI were not significant in multivariate analyses adjusted for age and gender. Moreover, there were no differences in recurrence-free survivals according to BMI quartiles (P=0.26).

Conclusion

In the present study, BMI was not associated with the aggressive clinicopathological features or recurrence-free survivals in patients with PTC.

Citations

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Giorgio Grani, Michele Gentili, Federico Siciliano, Domenico Albano, Valentina Zilioli, Silvia Morelli, Efisio Puxeddu, Maria Chiara Zatelli, Irene Gagliardi, Alessandro Piovesan, Alice Nervo, Umberto Crocetti, Michela Massa, Maria Teresa Samà, Chiara Mel
The Journal of Clinical Endocrinology & Metabolism.2023; 108(8): 1921. CrossRef
Potential impact of obesity on the aggressiveness of low- to intermediate-risk papillary thyroid carcinoma: results from a MASTER cohort study
Mijin Kim, Yae Eun Kang, Young Joo Park, Bon Seok Koo, Eu Jeong Ku, June Young Choi, Eun Kyung Lee, Bo Hyun Kim
Endocrine.2023; 82(1): 134. CrossRef
Potential Impact of Body Mass Index on the Clinical Outcome of Papillary Thyroid Cancer After High-Dose Radioactive Iodine Therapy
Jingjia Cao, Xiaolu Zhu, Yaru Sun, Xiao Li, Canhua Yun, Wei Zhang
Frontiers in Endocrinology.2022;[Epub] CrossRef
Nutritional status and follicular-derived thyroid cancer: An update
Luigi Barrea, Marco Gallo, Rosaria Maddalena Ruggeri, Paola Di Giacinto, Franz Sesti, Natalie Prinzi, Valerio Adinolfi, Viola Barucca, Valerio Renzelli, Giovanna Muscogiuri, Annamaria Colao, Roberto Baldelli
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Effects of concomitant obesity and diabetes on the aggressiveness and outcomes of differentiated thyroid cancer patients
Onur Elbasan, Dilek Gogas Yavuz
Archives of Endocrinology and Metabolism.2021;[Epub] CrossRef
Association of BMI with Clinicopathological Features of Papillary Thyroid Cancer: A Systematic Review and Meta‐Analysis
R. J. O'Neill, S. Abd Elwahab, M. J. Kerin, A. J. Lowery
World Journal of Surgery.2021; 45(9): 2805. CrossRef
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Aliki Economides, Konstantinos Giannakou, Ioannis Mamais, Panayiotis A. Economides, Panagiotis Papageorgis
Frontiers in Endocrinology.2021;[Epub] CrossRef
Potential Impact of BMI on the Aggressiveness of Presentation and Clinical Outcome of Differentiated Thyroid Cancer
Antonio Matrone, Giovanni Ceccarini, Marianna Beghini, Federica Ferrari, Carla Gambale, Mariaida D’Aqui, Paolo Piaggi, Liborio Torregrossa, Eleonora Molinaro, Fulvio Basolo, Paolo Vitti, Ferruccio Santini, Rossella Elisei
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Correlation between obesity and clinicopathological characteristics in patients with papillary thyroid cancer: a study of 1579 cases: a retrospective study
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Lack of association between obesity and aggressiveness of differentiated thyroid cancer
G. Grani, L. Lamartina, T. Montesano, G. Ronga, V. Maggisano, R. Falcone, V. Ramundo, L. Giacomelli, C. Durante, D. Russo, M. Maranghi
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Relu Cocoş, Sorina Schipor, Corin Badiu, Florina Raicu
Mitochondrion.2018; 39: 43. CrossRef
The impact of BMI on clinical progress, response to treatment, and disease course in patients with differentiated thyroid cancer
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Pretreatment BMI Is Associated with Aggressive Clinicopathological Features of Papillary Thyroid Carcinoma: A Multicenter Study
Shi-tong Yu, Wanzhi Chen, Qian Cai, Faya Liang, Debin Xu, Ping Han, Jichun Yu, Xiaoming Huang
International Journal of Endocrinology.2017; 2017: 1. CrossRef
Associations between body mass index and lymph node metastases of patients with papillary thyroid cancer
Changhua Wu, Liang Wang, Wanjun Chen, Shujuan Zou, Aiju Yang
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Comparison of Different Staging Systems for Predicting Recurrence of Papillary Thyroid Carcinoma.: Won Gu Kim, Eui Young Kim, Ji Hye Yim, Ji Min Han, Min Ji Jeon, Tae Yong Kim, Jin Sook Ryu, Gyungyub Gong, Suck Joon Hong, Won Bae Kim, Young Kee Shong; Endocrinol Metab. 2011;26(1):53-61. Published online March 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.1.53

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Abstract PDF

BACKGROUND
Various staging systems for thyroid cancer that focus on cancer specific death have been suggested, but this approach had a limitation due to the relatively long clinical course and very low rate of cancer death. This study was performed to evaluate the staging systems and to determine the most predictive staging system for predicting recurrence. METHODS: The patients who underwent first total or near total thyroidectomy due to papillary thyroid cancer (PTC) at Asan Medical Center between January 1995 and December 2001 were the subjects of this study. The commonly used 8 staging systems were applied to these subjects. Disease free survival (DFS) and the relative importance of each staging system were determined by the Kaplan-Meier method, the Cox-proportional hazards model and the proportion of variation in the survival time explained (PVE). RESULTS: A total of 952 patients (M = 117, F = 835) were enrolled and their mean age was 45 years. During a median of 10 years of follow-up, 146 (15.3%) of 952 patients had recurred tumor. The independent prognostic factors were male gender, tumor size, extrathyroidal invasion and cervical lymph node metastasis. Risk stratification according to the American thyroid association (ATA) guideline was the most predictive staging system for recurrence of PTC (PVE 88.6%). The staging systems from EORTC (PVE 79.5%), and MACIS (PVE 68.4%) had significant values for predicting recurrence of PTC. The stage of NTCTCS could not predict recurrence (PVE 4.5%, P = 0.11). CONCLUSION: Risk stratification according to the ATA was most predictive staging system for predicting recurrence of PTC. The MACIS and EORTC staging systems have good value for predicting recurrence of PTC.

Citations

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Unmet Clinical Needs in the Treatment of Patients with Thyroid Cancer
Won Bae Kim, Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Young Kee Shong
Endocrinology and Metabolism.2020; 35(1): 14. CrossRef
Impact of delayed radioiodine therapy in intermediate‐/high‐risk papillary thyroid carcinoma
Mijin Kim, Minkyu Han, Min Ji Jeon, Won Gu Kim, In Joo Kim, Jin‐Sook Ryu, Won Bae Kim, Young Kee Shong, Tae Yong Kim, Bo Hyun Kim
Clinical Endocrinology.2019; 91(3): 449. CrossRef
Clinical Value of Lymph Node Ratio Integration with the 8th Edition of the UICC TNM Classification and 2015 ATA Risk Stratification Systems for Recurrence Prediction in Papillary Thyroid Cancer
Jandee Lee, Seul Gi Lee, Kwangsoon Kim, Seung Hyuk Yim, Haengrang Ryu, Cho Rok Lee, Sang Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Young Suk Jo
Scientific Reports.2019;[Epub] CrossRef
Clinical prognostic significance of cancer stem cell markers in patients with papillary thyroid carcinoma
Yoon‑Jong Ryu, Ji‑Young Choe, Kyoungyul Lee, Soon‑Hyun Ahn
Oncology Letters.2019;[Epub] CrossRef
Dynamic Risk Stratification for Predicting Recurrence in Patients with Differentiated Thyroid Cancer Treated Without Radioactive Iodine Remnant Ablation Therapy
Suyeon Park, Won Gu Kim, Eyun Song, Hye-Seon Oh, Mijin Kim, Hyemi Kwon, Min Ji Jeon, Tae Yong Kim, Young Kee Shong, Won Bae Kim
Thyroid.2017; 27(4): 524. CrossRef
Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years?
Mijin Kim, Young Nam Kim, Won Gu Kim, Suyeon Park, Hyemi Kwon, Min Ji Jeon, Hyeon Seon Ahn, Sin-Ho Jung, Sun Wook Kim, Won Bae Kim, Jae Hoon Chung, Young Kee Shong, Tae Hyuk Kim, Tae Yong Kim
Clinical Endocrinology.2017; 86(3): 438. CrossRef
Sub-Classification of Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma by Pathologic Criteria
Min Ji Jeon, Won Gu Kim, Eun Kyung Jang, Yun Mi Choi, Dong Eun Song, Tae-Yon Sung, Jong Ho Yoon, Ki-Wook Chung, Suck Joon Hong, Jin-Sook Ryu, Ji Min Han, Tae Yong Kim, Young Kee Shong, Won Bae Kim, Konradin Metze
PLOS ONE.2015; 10(7): e0133625. CrossRef
Recent Changes in the Clinical Outcome of Papillary Thyroid Carcinoma With Cervical Lymph Node Metastasis
Min Ji Jeon, Won Gu Kim, Yun Mi Choi, Hyemi Kwon, Dong Eun Song, Yu-Mi Lee, Tae-Yon Sung, Jong Ho Yoon, Suck Joon Hong, Jung Hwan Baek, Jeong Hyun Lee, Jin-Sook Ryu, Tae Yong Kim, Young Kee Shong, Ki-Wook Chung, Won Bae Kim
The Journal of Clinical Endocrinology & Metabolism.2015; 100(9): 3470. CrossRef
Differentiating the location of cervical lymph node metastasis is very useful for estimating the risk of distant metastases in papillary thyroid carcinoma
Min Ji Jeon, Tae Yong Kim, Won Gu Kim, Ji Min Han, Eun Kyung Jang, Yun Mi Choi, Dong Eun Song, Jong Ho Yoon, Ki‐Wook Chung, Suck Joon Hong, Young Kee Shong, Won Bae Kim
Clinical Endocrinology.2014; 81(4): 593. CrossRef
Influences of Hashimoto's Thyroiditis as Prognostic Factor of Papillary Thyroid Carcinoma
Hyun Ju Park, Dong Kun Lee, Ji Won Seo, Myung Koo Kang, Heon Soo Park, Rock Bum Kim, Sung Hwan Suh, Mi Kyoung Park, Duk Kyu Kim, Jong Chul Hong
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2014; 57(5): 320. CrossRef

Postoperative Findings of the Cytological Diagnosis of Follicular Neoplasm or Hurthle Cell Neoplasm and the Risk of Malignancy.: Ji Hye Yim, Eui Young Kim, Won Gu Kim, Tae Yong Kim, Gyungyup Gong, Suck Joon Hong, Won Bae Kim, Young Kee Shong; Endocrinol Metab. 2010;25(4):316-320. Published online December 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.4.316

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Abstract PDF

BACKGROUND
Follicular neoplasm (FN) or Hurthle cell neoplasm (HN) is a less well understood pitfall when evaluating thyroid nodule with fine-needle aspiration (FNA). This study aimed to determine the rates of malignancy and the predictive factors for malignancy in thyroid nodules with a cytological diagnosis of FN or HN. METHODS: The patients who were cytologically diagnosed as having FN or HN after FNA between 1995 and 2004 at Asan Medical Center were included in this study. We collected the pathology data until 2009 and we analyzed the clinical characteristics associated with malignancy. RESULTS: A total 478 patients were cytologically diagnosed as having FN or HN during the study period and 327 (68%) among them underwent thyroid surgery. Thyroid malignancy was confirmed in 157 (48%) of 327 patients. Malignancy was confirmed in 124 patients with FN (124/253, 49%). They were 48 papillary, 65 follicular, 7 Hurthle cell and 3 medullary carcinomas and 1 anaplastic carcinoma. The malignancy in the cases of HN (33/71, 44.6%) was 9 papillary, 4 follicular and 20 Hurthle cell carcinomas. The risk of malignancy was not associated with male gender, a larger tumor size (> 4 cm) or the diagnosis of HN. However, an age below 20 years (RR 3.6, P = 0.03) and above 60 years (RR 2.3, P = 0.04) was associated with an increased risk of malignancy. CONCLUSION: About half of the patients with FN or HN on FNA cytology were diagnosed as having thyroid cancer after surgery. The malignancy rate for the cytologic diagnosis of HN was similar to that for FN. Thyroid surgery should be recommended for this situation, and especially for patients younger than 20 years or older than 60 years.

Citations

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Diagnostic Value of Preoperative Serum Thyroglobulin Measurement for the Diagnosis of Malignancy in Follicular or Hürthle Cell Neoplasms of the Thyroid Gland
Nam Kyu Kim, Seong Joo Kang, Weon Hyoung Lee, Go Eun Yeo, You Jin Han, Bu Kyung Kim, Su Kyoung Kwon, Yo-Han Park, Young Sik Choi
Kosin Medical Journal.2014; 29(1): 17. CrossRef
Fine Needle Aspiration Cytology of Thyroid Follicular Neoplasm: Cytohistologic Correlation and Accuracy
Changyoung Yoo, Hyun Joo Choi, Soyoung Im, Ji Han Jung, Kiouk Min, Chang Suk Kang, Young-Jin Suh
Korean Journal of Pathology.2013; 47(1): 61. CrossRef
Predictive Factors of Malignancy in Thyroid Nodules with a Cytological Diagnosis of Follicular Neoplasm
Seong Hyeon Lee, Jeong Su Baek, Joo Young Lee, Jung Ah Lim, Soo Youn Cho, Tae Hyun Lee, Yun Hyi Ku, Hong Il Kim, Min Joo Kim
Endocrine Pathology.2013; 24(4): 177. CrossRef
Postoperative Findings of the Cytological Diagnosis of Follicular Neoplasm or Hürthle Cell Neoplasm and Risk of Malignancy
Jung Uee Lee, Minho Shong
Endocrinology and Metabolism.2010; 25(4): 298. CrossRef

Factors Influencing Peripheral Conversion of Thyroxine to Tri-Iodothyronine in Athyreotic Individuals during Levothyroxine Replacement.: Eui Young Kim, Won Gu Kim, Tae Yong Kim, Jong Ho Yoon, Suck Joon Hong, Young Kee Shong, Won Bae Kim; Endocrinol Metab. 2010;25(2):119-124. Published online June 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.2.119

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Abstract PDF: BACKGROUND
Tri-iodothyronine (T3) is the main active hormone, and 20% of this is derived from the thyroid gland and 80% is from the peripheral tissue according to 5'-monodeiodination of thyroxine (T4). In the previous studies, normal T3 levels were achieved with traditional levothyroxine (LT4) therapy alone in athyreotic patients, but there has been no data about the factors influencing peripheral conversion of LT4. The aim of this study was to determine the factor(s) influencing peripheral conversion of LT4 to T3 in athyreotic patients during LT4 replacement. METHODS: The patients who underwent total-thyroidectomy for any cause, and mostly for thyroid cancers, at Asan Medical Center between 2000 and 2008 were enrolled. The free T4, T3 and thyroid stimulating hormone (TSH) levels and age, gender, weight, height, body mass index (BMI) and the T4 dose were measured. Only patients with normal ranges of free T4 and TSH were included in the analysis. RESULTS: A total of 143 patients were enrolled. The mean T3, free T4 and TSH levels were 143.7 ng/dL, 1.4 ng/dL and 1.6 microU/mL, respectively. The mean weight and BMI were 62.9 kg and 24.6 kg/m2, respectively. We divided them into two groups according to the serum T3 level and we compared the characteristics of the groups. There were no differences in age, the gender distribution, the T4 dose/weight and the BMI between the low T3 group (T3 < or = 122 ng/dL, n = 14) and the normal T3 group (T3 > 122 ng/dL, n = 129). In the low T3 group, the mean body weight was significantly lower than that of the normal T3 group (59.0 +/- 6.0 vs. 63.4 +/- 9.9, respectively, P = 0.025). CONCLUSION: Lean body mass seems to be an important factor for determining the peripheral conversion of T4 to T3 in human. This suggest that a combination of T3/T4 is better than T4 only when we treat the patients with hypothyroidism and who have a negligible amount of functioning thyroid tissue, if they have a low lean body mass.

Trends Analysis of Characteristics of Thyroid Cancer Patients in One Medical Center.: Seung Hun Lee, Tae Yong Kim, Jin Sook Ryu, Gyungyub Gong, Won Bae Kim, Seong Chul Kim, Suck Joon Hong, Young Kee Shong; J Korean Endocr Soc. 2008;23(1):35-43. Published online February 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.1.35

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Abstract PDF

BACKGROUND
The incidence of thyroid cancer is rapidly increasing. The aim of this study is to examine time trends in the characteristics of thyroid cancer and to determine the cause of the increase of thyroid cancer. METHODS: We evaluated 4,646 patients that underwent surgery at the Asan Medical Center for thyroid cancer between 1995 and 2006. Patients were evaluated concerning the histology, size of the primary tumor, sex, and age at the time of surgery. RESULTS: Surgically treated case of thyroid cancer increased from 91 in 1995 to 960 in 2006-a 10.5-fold increase during the 12-year period. Based on the histological categories, the proportion of papillary thyroid carcinomas (PTCs) increased from 79.1% to 94.5% during the 12-year period. According to the primary tumor size in the PTCs, the proportion of PTCs measuring 1 cm or smaller increased from 14% to 56% during the 12-year period. Whereas the proportion of PTCs measuring from 1 cm to 2 cm were similar (between 31% and 41% during the 12-year period), the proportion of PTC measuring from 2 cm to 4 cm decreased from 51% to 11% during the 12-year period. Thyroid cancer affected women more often than men by a ratio of 3.7. PTC was most common in patients in their forties, especially among women. CONCLUSIONS: The increasing number of surgically treated cases of thyroid cancer is predominantly due to an increase of papillary thyroid cancer measuring 1 cm or less. These trends suggest that the increase in surgically treated cases of thyroid cancer reflects increased detection of occult thyroid cancer due to advances in medical surveillance of impalpable nodules rather than a true increase in the number of thyroid cancers.

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Retraction of Publication

Retraction: Completion Thyroidectomy in Patient with Differentiated Thyroid Cancer Who Initially Underwent Ipsilateral Operation.: Eun Sook Kim, Jung Min Koh, Won Bae Kim, Suck Joon Hong, Young Kee Shong; J Korean Endocr Soc. 2007;22(6):480. Published online December 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.6.480

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Review Article

Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer.: Won Bae Kim, Tae Yong Kim, Hyuk Sang Kwon, Won Jin Moon, Jae Bok Lee, Young Sik Choi, Seok Ki Kim, Sun Wook Kim, Ki wook Chung, Jung Hwan Baek, Byung Il Kim, Do Joon Park, Dong Gyu Na, Jun Ho Choe, Jae Hoon Chung, Hye Seung Jung, Jeong Han Kim, Kee Hyun Nam, Hang Seok Chang, Woong Youn Chung, Soon Won Hong, Suck Joon Hong, Jeong Hyun Lee, Ka Hee Yi, Young Suk Jo, Ho Cheol Kang, Minho Shong, Jin Woo Park, Jong Ho Yoon, Seong Joon Kang, Kwang Woo Lee; J Korean Endocr Soc. 2007;22(3):157-187. Published online June 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.3.157

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Abstract PDF

No abstract available.

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Original Articles

Role of 5-aminoimidazole-4-carboxamide-1-beta-D-ribofuranoside in the Growth Regulation of Anaplastic Thyroid Cancer Cells Lines.: Ja Young Song, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Yoon Soo Rhee, Ji Hye Suck, Suck Joon Hong; J Korean Endocr Soc. 2006;21(2):125-131. Published online April 1, 2006; DOI: https://doi.org/10.3803/jkes.2008.21.2.125

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Abstract PDF: BACKGROUND
Anaplastic thyroid carcinoma is one of the most aggressive human cancers with a median survival of only 6 months. Local surgical tumor debulking combined with radio-chemotherapy is generally used to treat this malady, but the low success rate has prompted the search for new therapeutic targets. We used 5-aminoimidazole-4-carboxamide-1-beta-D-ribofuranoside (AICAR) as an AMP-activated protein kinase (AMPK) activator to induce growth suppression and apoptosis in the anaplastic thyroid carcinoma cells. METHODS: We investigated the effect of AICAR on the proliferation of thyroid cancer cell lines (ARO, WRO and FRO) by performing methyl-thiazoletetrazolium bromide assay. We wanted to see the effect of AICAR on the apoptosis and cell cycle of the thyroid cancer cells, and we wanted to determine the mechanism of these changes. RESULTS: The proliferation of all thyroid cancer cell lines was significantly inhibited by administration of AICAR. FRO was the most susceptible cell line to AICAR treatment and so further studies were then performed with this cell line. The suppressive effect of AICAR on cell proliferation was related with phosphorylation of AMPK and the increased apoptosis. Also, cell cycle analysis revealed that progression to the G2-M phase was arrested (S-phase arrest) by AICAR treatment. S-phase arrest was associated with the increased protein expression of p21. CONCLUSION: In the anaplastic thyroid cancer cell lines, AICAR inhibited proliferation due to the arrest in the S-phase; this was accompanied with the increased expression of p21. Overall, AMPK activation by AICAR or any other pharmacological agent could be a tempting potential target for thyroid cancer therapy.

Serum Thyroglobulin Levels Predicting Recurrence and Distant Metastasis after Surgery in Patients with Differentiated Thyroid Cancer.: Kyoung Soo Kim, Jin Sook Ryu, Suck Joon Hong, Won Bae Kim, Young Kee Shong; J Korean Endocr Soc. 2003;18(2):153-165. Published online April 1, 2003

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Abstract PDF: BACKGROUND
Reports on serum thyroglobulin(Tg) levels being used to predict recurrence or distant metastasis during the follow-up of patients with differentiated thyroid cancer(DTC) has been inconsistent. In addition, there have been few reports that attempt to define the cut-off value of Tg for recurrence or distant metastasis obtained by a receiver operating characteristic(ROC) curve. As well, there are differences in opinions on what the value should be on the first serum Tg level measured just before radioactive iodine(RAI) ablation(Tg-RAI), during thyroxine administration (Tg-on), and after thyroxine withdrawal(Tg-off) during the follow-up. Reports on the positive predictive values(PPVs) and negative predictive values(NPVs) of these Tg values are rare. METHODS: A total of 205 patients(42 males, 163 females) with DTC were studied. All patients had undergone total or near-total thyroidectomy. After surgery and RAI ablation, annual thyroxine withdrawal 131I-whole body scan(WBS) with Tg measurements was performed. The mean duration of follow-up was 5.0 (1.4~7.4) years. The most sensitive and specific Tg values(cut-off values) for tumor recurrence and/or distant metastasis were selected by using ROC curves. We also calculated the PPVs and NPVs for recurrence and/or distant metastasis using two-by-two tables. RESULTS: Cut-off values of Tg-RAI, Tg-on, and Tg-off for recurrence were 11.8, 1.4, and 3.3ng/mL, respectively. For these values, the sensitivities were 85.4, 82.2, and 93.3%, with the specificitiesat 89.2, 92.4, and 88.0%. PPVs were 71.9, 77.1, and 77.0% while NPVs were 95.0, 94,4, and 97.8%. The cut-off values for distant metastasis were 27.4, 2.5, and 7.9ng/mL, respectively. For these cut-off values, the sensitivities were 86.7, 87.5, and 92.3%, with the specificities being 86.2, 90.8, and 80.2%. PPVs were 34.2, 46.7, and 25.0% and NPVs were 98.7, 98.8, and 99.3%. CONCLUSION: All three serum Tg levels were sensitive and specific markers for recurrence and distant metastasis. Their PPVs were low in contrast to the high NPVs. In comparison with Tg-on, Tg-off showed higher sensitivity and NPV as well as lower specificity and PPV. Therefore, in the case of higher Tg-on during the follow-up period, efforts to find recurrence and distant metastasis,such as 131I-WBS, should be done. In addition, regular measurement of Tg-off or Tg after stimulation with recombinant human TSH is recommended as a screening test.

Completion Thyroidectomy in Patient with Differentiated Thyroid Cancer Who Initially Underwent Ipsilateral Operation.: Eun Sook Kim, Jung Min Koh, Won Bae Kim, Suck Joon Hong, Young Kee Shong; J Korean Endocr Soc. 2002;17(5):657-663. Published online October 1, 2002

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Abstract PDF: BACKGROUND
In some instances, thyroid cancer may be diagnosed only after resection of a putative or suspected benign nodule. In these cases a complete thyroidectomy is usually recommended to prevent recurrence. We analyzed the frequency of malignancy in the contralateral lobe after a complete thyroidectomy, and assessed the factors that may predict the presence of a malignancy, which might necessitate a complete thyroidectomy. METHODS: Between 1995 and 2001, 65 patients, who initially underwent a lobectomy and isthmectomy, but were finally diagnosed with differentiated thyroid carcinoma, underwent complete thyroidectomies. Their mean age was 39.8 +/- 12.4 years, ranging, 14 to 71 years. After initial surgery, 45 proved to have follicular carcinomas, 18 papillary carcinomas, 1 medullary and 1 insular carcinoma. The mean tumor size was 4.0 +/- 1.8 cm, ranging from 0.3 to 8.5 cm. After a complete thyroidectomy, the presence of a tumor the at contralateral lobe was assessed according to clinical parameters and the pathological findings in the ipsilateral lobe. RESULTS: The first surgeries revealed tumor multifocality in 27 cases, perithyroidal tumor extension in 4 and lymph node metastasis in 1. On completion of the thyroidectomy, 22 of the 65 patients had a malignancy in the contralateral lobe. Age, sex, size or the pathological primary tumor type, were not associated with the presence of additional tumors at the contralateral lobe. Tumor multifocality at the first surgery was the only significant variable to predict the presence of a tumor in the contralateral lobe. CONCLUSION: When thyroid cancer is diagnosed after ipsilateral surgery, the only predictive factor for the presence of a contralateral tumor was multifocality. We believe that a complete thyroidectomy is mandatory in these cases.

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