Endocrinology and Metabolism

Special Article

Miscellaneous
Immune Checkpoint Inhibitors and Endocrine Disorders: A Position Statement from the Korean Endocrine Society: Hyemi Kwon, Eun Roh, Chang Ho Ahn, Hee Kyung Kim, Cheol Ryong Ku, Kyong Yeun Jung, Ju Hee Lee, Eun Heui Kim, Sunghwan Suh, Sangmo Hong, Jeonghoon Ha, Jun Sung Moon, Jin Hwa Kim, Mi-kyung Kim, The Committee of Clinical Practice Guideline of the Korean Endocrine Society; Endocrinol Metab. 2022;37(6):839-850. Published online December 26, 2022; DOI: https://doi.org/10.3803/EnM.2022.1627

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Immune checkpoint inhibitors (ICIs) including an anti-cytotoxic T-lymphocyte-associated antigen 4 inhibitor, anti-programmed cell death protein 1 (PD-1) inhibitors, and anti-PD-ligand 1 inhibitors are representative therapeutics for various malignancies. In oncology, the application of ICIs is currently expanding to a wider range of malignancies due to their remarkable clinical outcomes. ICIs target immune checkpoints which suppress the activity of T-cells that are specific for tumor antigens, thereby allowing tumor cells to escape the immune response. However, immune checkpoints also play a crucial role in preventing autoimmune reactions. Therefore, ICIs targeting immune checkpoints can trigger various immune-related adverse events (irAEs), especially in endocrine organs. Considering the endocrine organs that are frequently involved, irAEs associated endocrinopathies are frequently life-threatening and have unfavorable clinical implications for patients. However, there are very limited data from large clinical trials that would inform the development of clinical guidelines for patients with irAEs associated endocrinopathies. Considering the current clinical situation, in which the scope and scale of the application of ICIs are increasing, position statements from clinical specialists play an essential role in providing the appropriate recommendations based on both medical evidence and clinical experience. As endocrinologists, we would like to present precautions and recommendations for the management of immune-related endocrine disorders, especially those involving the adrenal, thyroid, and pituitary glands caused by ICIs.

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Endocrinology and Metabolism.2023; 38(6): 750. CrossRef

Review Article

Thyroid
Euthyroid Thyroperoxidase Antibody Positivity during Pregnancy, to Treat or Not to Treat?: Tim I. M. Korevaar; Endocrinol Metab. 2022;37(3):387-391. Published online June 29, 2022; DOI: https://doi.org/10.3803/EnM.2022.301

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Thyroperoxidase antibody (TPOAb) positivity is a well-known risk factor for thyroid dysfunction during pregnancy and is associated with a suboptimal response to thyroidal stimulation by human chorionic gonadotropin. About 75% of TPOAb positive women are euthyroid and there seems to be a higher risk of predominantly miscarriage and preterm birth in this subgroup. Nonetheless, clinical decision making with regards to gestational levothyroxine treatment remains difficult due to a lack of large randomized trials. Future studies assessing dose-dependent associations and additional biomarkers that can distinguish low-risk from high-risk individuals will be key in disentangling the crude clinical data.

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Thyroid autoimmunity and adverse pregnancy outcomes: A multiple center retrospective study
Yun Xu, Hui Chen, Meng Ren, Yu Gao, Kan Sun, Hongshi Wu, Rui Ding, Junhui Wang, Zheqing Li, Dan Liu, Zilian Wang, Li Yan
Frontiers in Endocrinology.2023;[Epub] CrossRef
The Clinical Implications of Anti-thyroid Peroxidase Antibodies in Graves’ Disease in Basrah
Emad S Alhubaish, Nassar T Alibrahim, Abbas A Mansour
Cureus.2023;[Epub] CrossRef
Research Progress on the Influence of Autoimmune Thyroid Disease on Pregnancy Outcome
敏李
Advances in Clinical Medicine.2023; 13(08): 13720. CrossRef
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Karolina Kowalcze, Robert Krysiak, Anna Obuchowicz
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Original Articles

Thyroid
Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors: David Tak Wai Lui, Chi Ho Lee, Wing Sun Chow, Alan Chun Hong Lee, Anthony Raymond Tam, Carol Ho Yi Fong, Chun Yiu Law, Eunice Ka Hong Leung, Kelvin Kai Wang To, Kathryn Choon Beng Tan, Yu Cho Woo, Ching Wan Lam, Ivan Fan Ngai Hung, Karen Siu Ling Lam; Endocrinol Metab. 2021;36(3):582-589. Published online June 8, 2021; DOI: https://doi.org/10.3803/EnM.2021.983

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Background
The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors.
Methods
We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months.
Results
In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer.
Conclusion
Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

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The Influence of SARS-CoV-2 Infection on the Thyroid Gland
Aleksandra Piekarska, Marta Góral, Marta Kozula, Aleksandra Jawiarczyk-Przybyłowska, Katarzyna Zawadzka, Marek Bolanowski
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Endocrine Research
DEHP Down-Regulates Tshr Gene Expression in Rat Thyroid Tissues and FRTL-5 Rat Thyrocytes: A Potential Mechanism of Thyroid Disruption: Min Joo Kim, Hwan Hee Kim, Young Shin Song, Ok-Hee Kim, Kyungho Choi, Sujin Kim, Byung-Chul Oh, Young Joo Park; Endocrinol Metab. 2021;36(2):447-454. Published online March 31, 2021; DOI: https://doi.org/10.3803/EnM.2020.920

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Background
Di-2-ethylhexyl phthalate (DEHP) is known to disrupt thyroid hormonal status. However, the underlying molecular mechanism of this disruption is unclear. Therefore, we investigated the direct effects of DEHP on the thyroid gland.
Methods
DEHP (vehicle, 50 mg/kg, and 500 mg/kg) was administered to Sprague-Dawley rats for 2 weeks. The expression of the thyroid hormone synthesis pathway in rat thyroid tissues was analyzed through RNA sequencing analysis, quantitative reverse transcription-polymerase chain reaction (RT-PCR), and immunohistochemical (IHC) staining. DEHP was treated to FRTL-5 rat thyroid cells, and an RT-PCR analysis was performed. A reporter gene assay containing the promoter of thyroid stimulating hormone receptor (TSHR) in Nthy-ori 3-1 human thyroid cells was constructed, and luciferase activity was determined.
Results
After DEHP treatment, the free thyroxine (T4) and total T4 levels in rats significantly decreased. RNA sequencing analysis of rat thyroid tissues showed little difference between vehicle and DEHP groups. In the RT-PCR analysis, Tshr expression was significantly lower in both DEHP groups (50 and 500 mg/kg) compared to that in the vehicle group, and IHC staining showed that TSHR expression in the 50 mg/kg DEHP group significantly decreased. DEHP treatment to FRTL-5 cells significantly down-regulated Tshr expression. DEHP treatment also reduced luciferase activity in a reporter gene assay for TSHR.
Conclusion
Although overall genetic changes in the thyroid hormone synthesis pathway are not clear, DEHP exposure could significantly down-regulate Tshr expression in thyroid glands. Down-regulation of Tshr gene appears to be one of potential mechanisms of thyroid disruption by DEHP exposure.

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ARTS is essential for di-2-ethylhexyl phthalate (DEHP)-induced apoptosis of mouse Leydig cells
Yue Li, Linlin Xu, Chaoju Hao, Si Yang, Jinglei Wang, Jiaxiang Chen
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Thyroid dysfunction caused by exposure to environmental endocrine disruptors and the underlying mechanism: A review
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Intrauterine exposure to di(2-ethylhexyl) phthalate (DEHP) disrupts the function of the hypothalamus-pituitary-thyroid axis of the F1 rats during adult life
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Endocrine-disruptor endpoints in the ovary and thyroid of adult female rats exposed to realistic doses of di-(2-ethylhexyl) phthalate
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Review Articles

Miscellaneous
Rare PTH Gene Mutations Causing Parathyroid Disorders: A Review: Joon-Hyop Lee, Munkhtugs Davaatseren, Sihoon Lee; Endocrinol Metab. 2020;35(1):64-70. Published online March 19, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.1.64

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Since parathyroid hormone (PTH) was first isolated and its gene (PTH) was sequenced, only eight PTH mutations have been discovered. The C18R mutation in PTH, discovered in 1990, was the first to be reported. This autosomal dominant mutation induces endoplasmic reticulum stress and subsequent apoptosis in parathyroid cells. The next mutation, which was reported in 1992, is associated with exon skipping. The substitution of G with C in the first nucleotide of the second intron results in the exclusion of the second exon; since this exon includes the initiation codon, translation initiation is prevented. An S23P mutation and an S23X mutation at the same residue were reported in 1999 and 2012, respectively. Both mutations resulted in hypoparathyroidism. In 2008, a somatic R83X mutation was detected in a parathyroid adenoma tissue sample collected from a patient with hyperparathyroidism. In 2013, a heterozygous p.Met1_Asp6del mutation was incidentally discovered in a case-control study. Two years later, the R56C mutation was reported; this is the only reported hypoparathyroidism-causing mutation in the mature bioactive part of PTH. In 2017, another heterozygous mutation, M14K, was detected. The discovery of these eight mutations in the PTH gene has provided insights into its function and broadened our understanding of the molecular mechanisms underlying mutation progression. Further attempts to detect other such mutations will help elucidate the functions of PTH in a more sophisticated manner.

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Savita Khadse, Vrushali Satish Takalikar, Radha Ghildiyal, Nikhil Shah
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Homozygous Ser-1 to Pro-1 mutation in parathyroid hormone identified in hypocalcemic patients results in secretion of a biologically inactive pro-hormone
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Homozygous missense variant of PTH (c.166C>T, p.(Arg56Cys)) as the cause of familial isolated hypoparathyroidism in a three-year-old child
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Miscellaneous
Intraoperative Parathyroid Hormone Monitoring in the Surgical Management of Sporadic Primary Hyperparathyroidism: Zahra F. Khan, John I. Lew; Endocrinol Metab. 2019;34(4):327-339. Published online December 23, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.4.327

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Intraoperative parathyroid hormone monitoring (IPM) has been shown to be a useful adjunct during parathyroidectomy to ensure operative success at many specialized medical centers worldwide. Using the Miami or “>50% intraoperative PTH drop” criterion, IPM confirms the complete excision of all hyperfunctioning parathyroid tissue before the operation is finished, and helps guide the surgeon to identify additional hyperfunctioning parathyroid glands that may necessitate further extensive neck exploration when intraoperative parathyroid hormone (PTH) levels do not drop sufficiently. The intraoperative PTH assay is also used to differentiate parathyroid from non-parathyroid tissues during operations using fine needle aspiration samples and to lateralize the side of the neck harboring the hypersecreting parathyroid through differential jugular venous sampling when preoperative localization studies are negative or equivocal. The use of IPM underscores the recognition and understanding of sporadic primary hyperparathyroidism (SPHPT) as a disease of function rather than form, where the surgeon is better equipped to treat such patients with quantitative instead of qualitative information for durable long-term operative success. There has been a significant paradigm shift over the last 2 decades from conventional to focused parathyroidectomy guided by IPM. This approach has proven to be a safe and rapid operation requiring minimal dissection performed in an ambulatory setting for the treatment of SPHPT.

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Case Reports

A Case of Subsequent Papillary Carcinoma of the Thyroid gland and Hashimoto's Thyroiditis.: Sang Woong Han, Yong Seon So, Seok Hwan Kim, Ki Hyun Kwon, Tae Hyeung Kim, Jong Soon Kim, Kwang Hoe Kim, Byung Doo Lee; J Korean Endocr Soc. 1996;11(2):214-220. Published online November 7, 2019

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Abstract PDF: The association of thyroid carcinoma and Hashimotos thyroiditis in same thyroid gland is controversial. Incidence of carcinoma who has Hashimotos thyroiditis has been reported from 0.5 to 22.5 per cent by Crile and by Hirabayashi et al. The reason that there are such great diffarences in the reported incidences of carcinoma in Hashimotos disease is the result of the way the material is reported. The carcinomas of the thyroid which occur in association with Hashirnotos thyroiditis are predominently papillary tumors of lower grade malignancy. Thyroid carcinoma need not be feared in patimts with Hashimotos thymiditis, if one examines the ghmd catefully. When patients with Hashimotos disease are treated with thyroxine, there is little or no tendency for Hashimotos disease propess to clinieally detectable carcinoma of the thymid, and the microcarcinoma does not appear. In this case, single thyroid nodule was detected in Hashiimotos disease patient who was treated with thyroxine. There was no significant volume change of thyroid nodule despite of TSH suppression therapy during six months. Therefore we perforrned FNABC twice, the results were highly suspicious thyroid malignancy and subtotoal thyroidectomy was performed. The final pathologic result was microscopic papillary carcinoma with background Hashlmotos thyroiditis. In conclusion, we experienced a case of subsequent microscopic papillary carcinoma of the thyroid in patient with Hashimotos thyroiditis who was TSH suppression therapy with thyroxine.

Two Cases of Tubereuloeis of the Thyroid Gland with Euthyroidism.: Jae Bok Lee, Seok Man Son, Kyoung Seog Lee, Yeong Tae Jeong, In Joo Kim, Yong Ki Kim; J Korean Endocr Soc. 1994;9(4):380-384. Published online November 6, 2019

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Abstract PDF: Tuberculosis of the thyroid gland is extremely rare with few cases reported in recent years. Tuberculosis may involve the thyroid gland in two main forms. The more common of theses is miliary spread to the thyroid as part of generalized dissemination and less commonly focal or caseous tuberculosis of the thyroid may occur, presenting as a nodule, as a thyroiditis, as a abscess, or as carcinoma like.We experienced two cases of tuberculosis of the thyroid gland presenting with palpable thyroid nodule in 26 year-old female and 65 year-old female patients. They have been clinically and biochemically euthyroid and their thyroid scans demonstrated a cold nodule at right thyroid gland. We found no evidence of tuberculosis elsewhere. The goiter was removed surgically and confirmed to be tuberculosis. They were medicated antituberculous agents after operation and followed up regulary out patient department.We report the cases of two patients with tuberculosis involving thyroid with reviews of literature.

Original Articles

Thyroid Stimulating Hormone Reference Range and Prevalence of Thyroid Dysfunction in the Korean Population: Korea National Health and Nutrition Examination Survey 2013 to 2015: Won Gu Kim, Won Bae Kim, Gyeongji Woo, Hyejin Kim, Yumi Cho, Tae Yong Kim, Sun Wook Kim, Myung-Hee Shin, Jin Woo Park, Hai-Lin Park, Kyungwon Oh, Jae Hoon Chung; Endocrinol Metab. 2017;32(1):106-114. Published online January 23, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.1.106; Correction in: Endocrinol Metab 2023;38(3):357

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Abstract PDF PubReader

Background

No nationwide epidemiological study evaluating the prevalence of subclinical and overt forms of hypothyroidism and hyperthyroidism has yet been conducted in Korea. This study aimed to evaluate the reference range of serum thyroid stimulating hormone (TSH) and the national prevalence of thyroid dysfunctions in Korea.

Methods

Nation-wide cross-sectional data were analyzed from a representative sample of the civilian, non-institutionalized Korean population (n=6,564) who underwent blood testing for thyroid function and anti-thyroid peroxidase antibody (TPOAb) as part of the Korea National Health and Nutrition Examination Survey VI (2013 to 2015).

Results

The reference interval of serum TSH in the Korean reference population was 0.62 to 6.68 mIU/L. Based on this reference interval, the prevalence of overt and subclinical hypothyroidism was 0.73% (males 0.40%, females 1.10%) and 3.10% (males 2.26%, females 4.04%), respectively. The prevalence of hypothyroidism increased with age until the age group between 50 to 59 years. Positive TPOAb were found in 7.30% of subjects (males 4.33%, females 10.62%). The prevalence of overt and subclinical hypothyroidism TPOAb-positive subjects was 5.16% and 10.88%, respectively. The prevalence of overt and subclinical hyperthyroidism was 0.54% (males 0.30%, females 0.81%) and 2.98% (males 2.43%, females, 3.59%), respectively.

Conclusion

The Serum TSH reference levels in the Korean population were higher than the corresponding levels in Western countries. Differences were found in the prevalence of hypothyroidism and hyperthyroidism according to age, sex, and TPOAb positivity. This study provides important baseline information for understanding patterns of thyroid dysfunction and diseases in Korea.

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Endocrinology and Metabolism.2017; 32(2): 302. CrossRef
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Thyroid
Risk of Malignancy in Thyroid Incidentalomas Identified by Fluorodeoxyglucose-Positron Emission Tomography: A Reum Chun, Hye Min Jo, Seoung Ho Lee, Hong Woo Chun, Jung Mi Park, Kyu Jin Kim, Chan Hee Jung, Ji Oh Mok, Sung Koo Kang, Chul Hee Kim, Bo Yeon Kim; Endocrinol Metab. 2015;30(1):71-77. Published online March 27, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.1.71

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Background

Thyroid incidentalomas detected by 2-deoxy-2-¹⁸F-fluoro-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) have been reported in 1% to 4% of the population, with a risk of malignancy of 27.8% to 74%. We performed a retrospective review of FDG-avid thyroid incidentalomas in cancer screening subjects and patients with nonthyroid cancer. The risk of malignancy in thyroid incidentaloma and its association with the maximal standardized uptake value (SUV_max) in ¹⁸F-FDG PET/CT were evaluated to define the predictor variables in assessing risk of malignancy.

Methods

A total of 2,584 subjects underwent ¹⁸F-FDG PET/CT for metastatic evaluation or cancer screening from January 2005 to January 2010. Among them, 36 subjects with FDG-avid thyroid incidentalomas underwent further diagnostic evaluation (thyroid ultrasonography-guided fine needle aspiration cytology [FNAC] or surgical resection). We retrospectively reviewed the database of these subjects.

Results

Of the 2,584 subjects who underwent ¹⁸F-FDG PET/CT (319 for cancer screening and 2,265 for metastatic evaluation), 52 (2.0%) were identified as having FDG-avid thyroid incidentaloma and cytologic diagnosis was obtained by FNAC in 36 subjects. Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection. The positive predictive value of malignancy in FDG-avid thyroid incidentaloma was 41.7%. Median SUV_max was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001).

Conclusion

Thyroid incidentalomas found on ¹⁸F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%. FDG-avid thyroid incidentalomas with higher SUV_max tended to be malignant.

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Case Reports

Langerhans Cell Histiocytosis in the Thyroid and Draining Lymph Nodes: A Case Report.: Dong Hae Chung, Seung Yeon Ha, Hyun Yee Cho, Na Rae Kim, Jung Suk An, Young Don Lee, Sanghui Park; Endocrinol Metab. 2012;27(2):138-141. Published online June 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.2.138

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Abstract PDF

A 53-year-old woman was presented with several 0.3-0.6 cm-sized nodules within the right lobe of the thyroid. Histologic sections of the thyroid demonstrated multiple papillary microcarcinomas in the background of lymphocytic thyroiditis, with a small focus of Langerhans cell histiocytosis (LCH). Small LCH nodules were also found in the draining cervical lymph nodes. Although the association of LCH with papillary thyroid carcinoma in the thyroid has been reported, their co-existence with LCH in the draining lymph nodes is very rare.

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A Case of Solitary Extramedullary Plasmacytoma of the Thyroid Presented as a Thyroid Tumor with Hashimoto's Thyroiditis.: Eunjung Jo, Dong Woo Ha, Jin Hee Choi, Kyung Nam Lee, Jung Seop Eom, Mi Ra Kim, Yun Kyung Jeon, Sang Soo Kim, Bo Hyun Kim, In Joo Kim; Endocrinol Metab. 2012;27(1):77-82. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.77

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Abstract PDF

Extramedullary plasmacytomas most commonly occur in the nasal cavity, nasopharynx, paranasal sinuses, and larynx. Solitary extramedullary plasmacytoma (SEP) of the thyroid gland is rare. The diagnosis of SEP of the thyroid by cytology is typically difficult before surgery, and the entity is often confused with different cytology findings. We report a case of a 59-year-old man with primary plasmacytoma of the thyroid presented as a rapidly enlarging thyroid gland with Hashimoto's thyroiditis. He had been suffering from anterior neck swelling for 1 month. Several fine-needle aspiration biopsies yielded Hashimoto's thyroiditis. During a follow-up period of 3 years, the size of the thyroid gland increased and a mass lesion in right thyroid gland was detected. A total thyroidectomy was performed based on a diagnosis of a thyroid tumor with Hashimoto's thyroiditis. Permanent pathology identified the mass as an extramedullary plasmacytoma associated with Hashimoto's thyroiditis. Skeletal survey and serum electrophoresis tests were normal, and a bone marrow biopsy yielded no evidence of multiple myeloma. The patient underwent definitive radiotherapy and remained free from any recurrences during follow-up.

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It's not all about the thyroid! Extrinsic and unusual pathology affecting the thyroid gland: A pictorial review
Edward Walker, Shishir Karthik, Preetha Chengot, Sriram Vaidyanathan
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A Case of Hyalinizing Trabecular Adenoma of the Thyroid Gland.: Hyun Won Shin, Young Lyun Oh, Hye Won Jang, Ji In Lee, Sun Wook Kim, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung; J Korean Endocr Soc. 2009;24(1):54-57. Published online March 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.1.54

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Abstract PDF

Hyalinizing trabecular tumor is a rare benign thyroid tumor first described by Carney et al. in 1987. The tumor is characterized by an encapsulated nodule, trabecular arrangement of polygonal, oval, elongated cells, and hyalinized stroma. It is easily confused with papillary thyroid carcinoma or medullary thyroid carcinoma on surgical and cytologic specimens. A 45-year-old man presented with an incidentally detected left thyroid mass. Fine needle aspiration was performed and papillary thyroid carcinoma was suspected. However, the surgical specimen revealed a hyalinizing trabecular adenoma. We present this hyalinizing trabecular adenoma case to share our experience with physicians and specialists.

Citations

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A Case of Multifocal Hyalinizing Trabecular Tumors of the Thyroid Gland
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A Case of Carcinoma Showing Thymus-Like Differentiation (CASTLE) in the Thyroid.: Eun Hee Kim, Ji Yun Jeong, Eui Young Kim, Sang Ah Lee, Kyung Min Kim, Ji Hye Yim, Won Gu Kim, Tae Yong Kim, Sun A Kim, Gyungyup Gong, Young Kee Shong, Won Bae Kim; J Korean Endocr Soc. 2008;23(4):272-276. Published online August 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.4.272

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Abstract PDF

Carcinoma Showing Thymus-Like Differentiation (CASTLE) is a very rare malignant neoplasm of the thyroid, and this resembles lymphoepithelioma or squamous cell carcinoma of the thymus. It originates from ectopic thymic tissue or remnants of the branchial pouches. We recently experienced a case of CASTLE in the thyroid gland of a 61-year-old woman. She presented with an asymptomatic mass in the right thyroid gland and she was diagnosed with 'poorly differentiated carcinoma' of the thyroid by fine needle aspiration cytology (FNAC). Total thyroidectomy was performed for both diagnostic and therapeutic purposes. Histologic examination of the resected tumor showed that the tumor was lobulated with expanding fibrous bands, and it was infiltrated by lymphocytes and plasma cells. The tumor cells had oval, large vesicular nuclei and prominent nucleoli, and the immunohistochemical staining was positive for CD5 and bcl-2, so the patient was diagnosed with thyroid CASTLE. We report here on a case of CASTLE in the thyroid gland treated by surgery and external neck radiation therapy.

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Intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation: Case report with cytomorphology, immunocytochemistry, and review of the literature focusing on cytology
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A Case of Diffuse Hemorrhage into the Thyroid Gland after Fine Needle Aspiration, and This was Treated by Arterial Embolization.: Eui Young Kim, Jung Min Kim, Eun Hee Kim, Ji Yun Jeong, Sang Ah Lee, Ji Young Choi, Ji Hye Yim, Pil Hyung Lee, Tae Yong Kim, Young Kee Shong, Won Bae Kim; J Korean Endocr Soc. 2008;23(3):199-203. Published online June 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.3.199

1,996 View
27 Download
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Abstract PDF

Although hematoma formation after fine needle aspiration cytology fine needle aspiration cytology (FNAC) is a most common complication and most of these hematomas are self-limiting with minimal pain, a massive intra-thyroidal hemorrhage that produces acute airway obstruction had rarely been reported on.

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