Endocrinology and Metabolism

Dong Won Byun (Byun DW)

14 Articles

Clinical Study
Triiodothyronine Levels Are Independently Associated with Metabolic Syndrome in Euthyroid Middle-Aged Subjects: Hye Jeong Kim, Ji Cheol Bae, Hyeong Kyu Park, Dong Won Byun, Kyoil Suh, Myung Hi Yoo, Jae Hyeon Kim, Yong-Ki Min, Sun Wook Kim, Jae Hoon Chung; Endocrinol Metab. 2016;31(2):311-319. Published online May 13, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.2.311

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Background

Recent studies have shown an association between thyroid hormone levels and metabolic syndrome (MetS) among euthyroid individuals; however, there have been some inconsistencies between studies. Here, we evaluated the relationship between thyroid hormone levels and MetS in euthyroid middle-aged subjects in a large cohort.

Methods

A retrospective analysis of 13,496 euthyroid middle-aged subjects who participated in comprehensive health examinations was performed. Subjects were grouped according to thyroid stimulating hormone, total triiodothyronine (T3), total thyroxine (T4), and T3-to-T4 ratio quartile categories. We estimated the odds ratios (ORs) for MetS according to thyroid hormone quartiles using logistic regression models, adjusted for potential confounders.

Results

Of the study patients, 12% (n=1,664) had MetS. A higher T3 level and T3-to-T4 ratio were associated with unfavourable metabolic profiles, such as higher body mass index, systolic and diastolic blood pressure, triglycerides, fasting glucose and glycated hemoglobin, and lower high density lipoprotein cholesterol levels. The proportion of participants with MetS increased across the T3 quartile categories (P for trend <0.001) and the T3-to-T4 ratio quartile categories (P for trend <0.001). The multi-variate-adjusted OR (95% confidence interval) for MetS in the highest T3 quartile group was 1.249 (1.020 to 1.529) compared to the lowest T3 quartile group, and that in the highest T3-to-T4 ratio quartile group was 1.458 (1.141 to 1.863) compared to the lowest T3-to-T4 ratio quartile group, even after adjustment for potential confounders.

Conclusion

Serum T3 levels and T3-to-T4 ratio are independently associated with MetS in euthyroid middle-aged subjects. Longitudinal studies are needed to define this association and its potential health implications.

Citations

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Maša Kenda, Urša Pečar Fonović, Janko Kos, Marija Sollner Dolenc
Toxicology in Vitro.2022; 79: 105275. CrossRef
Could the ketogenic diet induce a shift in thyroid function and support a metabolic advantage in healthy participants? A pilot randomized-controlled-crossover trial
Stella Iacovides, Shane K. Maloney, Sindeep Bhana, Zareena Angamia, Rebecca M. Meiring, Carla Pegoraro
PLOS ONE.2022; 17(6): e0269440. CrossRef
Mediation effects of thyroid function in the associations between phthalate exposure and lipid metabolism in adults
Han-Bin Huang, Po-Keng Cheng, Chi-Ying Siao, Yuan-Ting C. Lo, Wei-Chun Chou, Po-Chin Huang
Environmental Health.2022;[Epub] CrossRef
Cholinesterase homozygous genotype as susceptible biomarker of hypertriglyceridaemia for pesticide-exposed agricultural workers
Xingfan Zhou, Min Zhang, Yuqian Wang, Hailing Xia, Lijin Zhu, Guangyi Li, Li Rong, Huahuang Dong, Rui Chen, Shichuan Tang, Min Yu
Biomarkers.2021; 26(4): 335. CrossRef
Association between thyroid hormone and components of metabolic syndrome in euthyroid Korean adults
Kyung A. Shin, Eun Jae Kim
Medicine.2021; 100(51): e28409. CrossRef
Clinical Parameters Are More Likely to Be Associated with Thyroid Hormone Levels than with Thyrotropin Levels: A Systematic Review and Meta-Analysis
Stephen P. Fitzgerald, Nigel G. Bean, Henrik Falhammar, Jono Tuke
Thyroid.2020; 30(12): 1695. CrossRef
The role of thyroid hormone in metabolism and metabolic syndrome
Patrícia de Fátima dos Santos Teixeira, Patrícia Borges dos Santos, Carmen Cabanelas Pazos-Moura
Therapeutic Advances in Endocrinology and Metabolism.2020; 11: 204201882091786. CrossRef
Association between Abdominal Fat Distribution and Free Triiodothyronine in a Euthyroid Population
Xiaomin Nie, Yiting Xu, Xiaojing Ma, Yunfeng Xiao, Yufei Wang, Yuqian Bao
Obesity Facts.2020; 13(3): 358. CrossRef
Association of thyroid function with white coat hypertension and sustained hypertension
Peng Cai, Yan Peng, YuXi Chen, Li Li, Wei Chu, Yan Wang, Xukai Wang
The Journal of Clinical Hypertension.2019; 21(5): 674. CrossRef
Thyroid function is associated with body mass index and fasting plasma glucose in Thai euthyroid population
Amornpan Lertrit, La-or Chailurkit, Boonsong Ongphiphadhanakul, Wichai Aekplakorn, Chutintorn Sriphrapradang
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2019; 13(1): 468. CrossRef
Thyroid disease and the metabolic syndrome
Ladan Mehran, Atieh Amouzegar, Fereidoun Azizi
Current Opinion in Endocrinology, Diabetes & Obesity.2019; 26(5): 256. CrossRef
Morbid obez hastalarda kilo kaybının insulin direnci, bazal metabolizma hızı, antropometrik ölçümler ve tiroid fonksiyonlarına etkisi
Şenay DURMAZ CEYLAN, Şuuri Ahsen CEYLAN, Fatih EKER, Aşkın GÜNGÜNEŞ
Anadolu Güncel Tıp Dergisi.2019; 1(4): 99. CrossRef
Body Composition, Resting Energy Expenditure, and Metabolic Changes in Women Diagnosed with Differentiated Thyroid Carcinoma
Elena Izkhakov, Nachum Vaisman, Sophie Barnes, Micha Barchana, Naftali Stern, Lital Keinan-Boker
Thyroid.2019; 29(8): 1044. CrossRef
High TSH Level within Normal Range Is Associated with Obesity, Dyslipidemia, Hypertension, Inflammation, Hypercoagulability, and the Metabolic Syndrome: A Novel Cardiometabolic Marker
Yi-Cheng Chang, Shih-Che Hua, Chia-Hsuin Chang, Wei-Yi Kao, Hsiao-Lin Lee, Lee-Ming Chuang, Yen-Tsung Huang, Mei-Shu Lai
Journal of Clinical Medicine.2019; 8(6): 817. CrossRef
Metabolic Syndrome, Thyroid Function and Autoimmunity - The PORMETS Study
Luís Raposo, Sandra Martins, Daniela Ferreira, João Tiago Guimarães, Ana Cristina Santos
Endocrine, Metabolic & Immune Disorders - Drug Targets.2019; 19(1): 75. CrossRef
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Xin Li, Tingting Yang, Zheng Sun
Trends in Endocrinology & Metabolism.2019; 30(12): 944. CrossRef
Relationship of metabolic syndrome and its components with thyroid dysfunction in Algerian patients
Mohamed Larbi Hamlaoui, Ammar Ayachi, Aoulia Dekaken, Adel Gouri
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2018; 12(1): 1. CrossRef
High free triiodothyronine and free-triiodothyronine-to-free-thyroxine ratio levels are associated with metabolic syndrome in a euthyroid population
Diego Urrunaga-Pastor, Mirella Guarnizo-Poma, Enrique Moncada-Mapelli, Luis G. Aguirre, Herbert Lazaro-Alcantara, Socorro Paico-Palacios, Betzi Pantoja-Torres, Vicente A. Benites-Zapata
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2018; 12(2): 155. CrossRef
Exploring the association between thyroid- stimulating hormone and metabolic syndrome: A large population-based study
Yi-Chao Zhou, Wen-Hui Fang, Tung-Wei Kao, Chung-Ching Wang, Yaw-Wen Chang, Tao-Chun Peng, Chen-Jung Wu, Hui-Fang Yang, James Yi-Hsin Chan, Wei-Liang Chen, Tatsuo Shimosawa
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Thyroid function and metabolic syndrome in the population-based LifeLines cohort study
Bruce H. R. Wolffenbuttel, Hanneke J. C. M. Wouters, Sandra N. Slagter, Robert P. van Waateringe, Anneke C. Muller Kobold, Jana V. van Vliet-Ostaptchouk, Thera P. Links, Melanie M. van der Klauw
BMC Endocrine Disorders.2017;[Epub] CrossRef
Hormetic effect of triiodothyronine in metabolically healthy obese persons
Ji Eun Jun, Tae Hyuk Kim, Seung-Eun Lee, You-Bin Lee, Jae Hwan Jee, Ji Cheol Bae, Sang-Man Jin, Kyu Yeon Hur, Jae Hyeon Kim, Sun Wook Kim, Jae Hoon Chung, Yong-Ki Min, Moon-Kyu Lee
Endocrine.2017; 57(3): 418. CrossRef
Association of triiodothyronine levels with future development of metabolic syndrome in euthyroid middle-aged subjects: a 6-year retrospective longitudinal study
Hye Jeong Kim, Ji Cheol Bae, Hyeong Kyu Park, Dong Won Byun, Kyoil Suh, Myung Hi Yoo, Jee Jae Hwan, Jae Hyeon Kim, Yong-Ki Min, Sun Wook Kim, Jae Hoon Chung
European Journal of Endocrinology.2017; 176(4): 443. CrossRef
Articles inEndocrinology and Metabolismin 2016
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Endocrinology and Metabolism.2017; 32(1): 62. CrossRef

A Case of Residual Medullary Thyroid Carcinoma Detected by 18F-FDG-PET/CT in Patient with Persistent Hypercalcitoninemia.: Ji Yon Kim, Dong Won Byun, Kyo Il Seo, So Young Jin, Myung Hi Yoo; Endocrinol Metab. 2010;25(4):365-369. Published online December 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.4.365

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Abstract PDF: Medullary thyroid carcinoma (MTC) is a rare and challenging malignancy. In patients with residual MTC, the tumor detection rate is generally low for most of the currently available imaging techniques. Various imaging methods have already been used for the detection of residual tumor, but no modality has been shown to be superior to others. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently been proposed to identify residual MTC, but this procedure also has limitations as small masses are rarely detected. So, a multimodality imaging approach is recommended for detecting residual MTC. We report here on a case of residual MTC that was detected by 18F-FDG PET/CT in a patient with persistent hypercalcitoninemia after total thyroidectomy and bilateral lymph node dissection.

A Case of Improved Diabetes Mellitus After Removal of Nonfunctioning Adrenal Incidentaloma Diagnosed as Pheochromocytoma.: Se Kyung Park, Duk Su Kim, Mi Oh Roh, Min Soo Song, Chan Hee Jung, Jung Hwa Jung, Hyeong Kyu Park, Yeo Ju Kim, Ji Oh Mok, Sang Jin Kim, Chul Hee Kim, Dong Won Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2009;24(3):189-194. Published online September 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.3.189

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Abstract PDF: Pheochromocytoma not only decreases insulin secretion but also increases insulin resistance. One third of patients with pheochromocytoma have diabetes mellitus and their clinical prognosis showed improvement after surgery. Until now, those patients whose prognosis for diabetes mellitus improved after the operation of pheochromocytoma had typical characteristics such as hypertension, palpitation, headache and elevated hormones such as Vanillylmandelic acid, metanephrine, epinephrine and norepinephrine. We present the case of a 75-year-old woman with asymptomatic adrenal incidentaloma identified as pheochromocytoma which exhibited normal biochemical test results, and after removal of the abdominal mass, her severe hyperglycemia improved.

A Case of Primary Hypothyroidism with Anti-Triiodothyronine Autoantibody.: Jae Ho Park, Ji Hoon Ahn, Mi Hee Kang, Jong Chul Won, Kyung Wook Lee, Yeo Joo Kim, Ji Oh Mok, Hyeong Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2006;21(5):428-432. Published online October 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.5.428

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Abstract PDF

Antithyroid hormone autoantibodies can be present in the sera of patients with thyroid and non-thyroid disorders. Antithyroid hormone autoantibodies in a patient's serum interfere with radioimmunoassay of thyroid hormones. Clinically, this interference can result in discordance between the serum thyroid hormone levels and the clinical features of the patient, which can lead to misdiagnosis or inappropriate treatment. We experienced a woman who had primary hypothyroidism with unexpectedly high concentrations of serum total triiodothyronine (T(3)) and free T(3), and she had been treated for Graves' disease in the past. Through the use of a polyethylene glycol precipitation method, we detected the anti-triiodothyronine autoantibodies in her serum. We report on this case along with a review of the related literature.

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Thyroxine (T4) Autoantibody Interference of Free T4 Concentration Measurement in a Patient With Hashimoto’s Thyroiditis
Mi-Na Lee, Soo-Youn Lee, Kyu Yeon Hur, Hyung-Doo Park
Annals of Laboratory Medicine.2017; 37(2): 169. CrossRef

A Case of Papillary Thyroid Carcinoma Combined with Metastatic Renal Cell Carcinoma in the Thyroid.: Kang Il Cheon, Kyung Wook Lee, Ji Oh Mok, Yeo Ju Kim, Hyung Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo, Hee Kyung Kim, Youn Woo Ko; J Korean Endocr Soc. 2006;21(1):85-89. Published online February 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.1.85

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Abstract PDF

Metastasis to the thyroid from distant cancer is rarely diagnosed clinically and renal cell carcinoma is the most common group of neoplasm to metastasize to the thyroid. Papillary thyroid carcinoma is known as the most frequent primary thyroid cancer. But coexistence with metastatic renal cell carcinoma to thyroid and papillary thyroid carcinoma is very rare. We are reporting this highly unusual case of metastatic renal cell carcinoma to thyroid, which harbored papillary thyroid cancer. To our knowledge, this is the first case reported in Korea. A 57-year-old woman presented with hoarseness and palpable anterior neck mass. She had a history of renal cell carcinoma of right kidney, which had been resected 10 years previously and had undergone lower anterior resection due to sigmoid colon cancer 2 months before. Fine needle aspiration cytology suggested follicular neoplasm, and total thyroidectomy was performed. The pathology from the thyroid nodules showed papillary thyroid cancer combined metastatic renal cell carcinoma.

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A Case of Metastatic Renal Cell Carcinoma to Thyroid Gland Mimicking as Anaplastic Thyroid Carcinoma
Sooyeon Jo, Hyung Gyun Na, Chang Hoon Bae, Yoon Seok Choi
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2021; 64(10): 755. CrossRef

A Case of Panhypopituitarism with Rhabdomyolysis.: Sung Wook Hong, Eun Jung Lee, Ji Young Park, Ji Sung Yoon, Ji O Mok, Yeo Joo Kim, Hyeong Kyu Park, Jae Woo Kim, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2005;20(2):174-178. Published online April 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.2.174

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Abstract PDF: Rhabdomyolysis is the consequence of extensive muscle injury with the release of muscle cell constituents into plasma. It can arise from trauma and also from a variety of nontraumatic causes. Trauma, drugs, toxins and infection are the major causes of rhabdomyolysis, but it is rarely associated with metabolic disorders such as severe electrolyte disturbance, diabetic ketoacidosis, hyperosmolar nonketotic coma, hypothyroidism and thyrotoxicosis. There have been several reported cases of metabolic rhabdomyolysis, but panhypopituitarism as a cause has never been identified. We experienced a case of acute rhabdomyolysis associated with panhypopituitarism. Thus, So we report this case with the review of related literature. Metabolic disorder is a rare cause of rhabdomyolysis, but it should always be considered in a patient having and unexplained increased of the creatine kinase concentration

A Case of Kallmann's Syndrome with Unilateral Renal Aplasia and Diabetes Mellitus.: En Jung Lee, Sung Wook Hong, Yun Ki Hong, Ji Sung Yoon, Ji O Mok, Yeo Joo Kim, Hyeong Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Won Kyung Bae, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2005;20(1):96-102. Published online February 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.1.96

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Abstract PDF

Kallmann's syndrome is defined as the combination of hypogonadotropic hypogonadism and anosmia/hyposmia. The syndrome is a result of defect in the embryonic migratory pathway of gonadotropin-releasing hormone, which synthesizes neurons and olfactory axons. The hypogonadotropic hypogonadism results due to absence of or incomplete pubertal development and may be associated with anosmia, hyposmia, midline defect(color blindness, cleft-lip, cleft-palate, unilateral renal agenesis, sensorineural deafness), cryptorchidism and skeletal anomaly. Till date in Korea, few cases of Kallmann's syndrome have been reported but there are no available reports on cases of Kallmann's syndrome with unilateral renal aplasia and diabetes mellitus. We handled a case of Kallmann's syndrome associated with unilateral renal agenesis and diabetes mellitus. In the current work, we present a peculiar case as afore mentioned with the review of related literature.

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A Case of Kallmann's Syndrome with Frontal Lobe Atrophy and Mental Retardation
Soyoung Hyun, Seungguk Park, Dong Gu Kang, Seung Uk Jeong, Dea Ho Lee, Gwanpyo Koh
Endocrinology and Metabolism.2010; 25(2): 142. CrossRef
A Case of Kallmann's Syndrome Mildly Presenting as Secondary Amenorrhea
Na Rae Joo, Cheol Young Park, Hong Ju Moon, Jun Goo Kang, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo, Yul Lee, Ki Won Oh, Sung woo Park
Journal of Korean Endocrine Society.2007; 22(2): 130. CrossRef

A Case of Thyrotoxic Paraplegia.: Gun Wha Lee, Jin Woo Park, Ji Sung Yoon, Ji O Mok, Yeo Joo Kim, Hyeong Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo, Du Shin Jeong; J Korean Endocr Soc. 2004;19(4):419-425. Published online August 1, 2004

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Abstract PDF: Hyperthyroidism may be associated or present with a variety of neuromuscular disorders, including thyrotoxic myopathy, exophthalmic ophthalmoplegia, periodic paralysis and myasthenia gravis. In contrast to muscle, peripheral nerve involvement in hyperthyroidism is exceedingly rare, and has received little attention. Paraplegia-like weakness during severe hyperthyroidism was first described by Charcot in 1889, and called Basedow's paraplegia' by Joffory in 1894. However, there has been no reported case in Korea. A 38-year-old woman was admitted for evaluation of progressive weakness and a gait disturbance. Her endocrinological results were compatible with hyperthyroidism. The polyneuropathy was also confirmed with sequential electrophysiological studies of the nerves and muscles. Drug therapy for hyperthyroidism resulted in resolution of the clinical neurological symptoms and progressive improvement of electrophysiological findings. Hyperthyroidisms are common medical disorders, which are often accompanied by diverse types of neurological and neuromuscular dysfunctions. All of these neurological manifestations are important, as they can serve as important clues to the diagnosis of a thyroid disorder. Furthermore, they are often related to the patient's presenting complaint. Therefore, the physician must be alert to the diverse manifestations of thyroid dysfunction, as they can lead to the diagnosis of potentially serious but treatable disorders. Herein is reported a case of myopathy and neuropathy associated with hyperthyroidism (Basedow's paraplegia), with a review of the literature

Increased Activity of Insulin-like Growth Factor binding Protein-4 Protease in H-mole Patients.: Woo Seok Seo, Dong Won Byun, Ji Oh Mok, Ji Sung Yoon, Yeo Joo Kim, Hyung Kyu Park, Chul Hee Kim, Sang Jin Kim, Kyo Il Suh, Myung Hi Yoo, Hae Hyeog Lee, Soo Kyoon Rah; J Korean Endocr Soc. 2004;19(4):346-357. Published online August 1, 2004

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Abstract PDF: BACKGROUND
Hydatidiform mole (H-mole) is characterized by the neoplastic proliferation of trophoblasts. Only 1~10% of patients with partial H-mole will develop a trophoblastic tumor, but 18~29% of those with complete H-mole will develop a persistent trophoblastic tumor. Therefore, the early diagnosis and monitoring after operation of an H-mole disease are very important. Recently, the pregnancy associated plasma protein-A (PAPP-A) was proved to have a similar role as that of IGF binding protein-4 (IGFBP-4) protease, which has shown an increasing function in fetal growth and development by degradation of IGFBP-4 and an increase in IGF in the serum during pregnancy. Our hypothesis is "the H-mole, which shows placental hyperplasia will also have an IGFBP-4 protease activity, which may be used as in the early diagnosis and monitoring of H-mole disease". METHODS: Serum samples from 6 non-pregnant, 18 pregnant (5 in the 1st trimester, 10 in the 2nd, and 3 in the 3rd), 12 postpartum women and 3 H-mole patients(2 with complete H-mole and 1with partial H-mole) were collected and measured for the -HCG, IGF and PAPP-A levels and IGFBP-4 protease activities by a IGF-II ligand blot analysis and electrophoresis method. The IGFBP-4 protease activity of the serum during normal pregnancy was compared with that of H-mole disease. RESULTS: The results from the in vitro protease assays using recombinant IGFBP-4 determined that IGFBP-4 proteolysis was significantly increased during the first (56%) and second trimesters (90%), but reached a plateau by the third trimester (94%). In H-mole disease diagnosed 11 weeks after conception, the IGFBP-4 proteolytic activity was 97%, which was nearly the same as at terminal pregnancy. This activity gradually decreased to 75% at 1 week, 58.7% at 2 and 33% at 3 weeks after the operation. The -HCG was also decreased from 490,400 to 123,822.7, 1,352.3, and 128.5 mIU/mL at 1, 2 and 3 weeks after the operation, respectively. The PAPP-A level also gradually decreased from 34.87 to 25.5, 12.0 and 2.7 g/mL 1, 2 and 3 weeks after the operation, respectively. However, the IGF decreased from 238.3 to 172.9 ng/mL 1 week after the operation, but increased to 251.4 and 295 ng/mL at 2 and 3 weeks after the operation, respectively. CONCLUSION: These results demonstrated that the IGFBP-4 protease activity was significantly increased during pregnancy, and was extremely elevated durimg the early stages of H-mole disease, but gradually decreased after removal of molar tissue. Therefore, measuring the IGFBP-4 protease activity may play an important role in the early diagnosis and monitoring of H-mole disease

A Case of Severe Thyrotoxicosis Induced by Hydatidiform Mole.: Jae Hak Lee, Jong Kun Park, Soon Hyo Kwon, Ji Oh Mok, Ji Sung Yoon, Yeo Joo Kim, Hyung Kyu Park, Chul Hee Kim, Sang Jin Kim, Hae Hyeog Lee, Gye Hyun Nam, Gye Hyun Kwan, Eun Suk Ko, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2003;18(4):420-425. Published online August 1, 2003

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Abstract PDF: Human chorionic gonadotropin (HCG) is one of the glycoproteins families synthesized by the placenta, and consists of 2 noncovalently joined subunits, namely, alpha and beta. The alpha and beta-subunits have a structural homology with the alpha and beta-subunits of TSH and LH. The thyrotropic action of HCG results from its structural similarity to TSH, so beta-HCG can bind to the TSH receptor in the thyroid gland. A high level of HCG, accompanied by an increased thyroid hormone level, can be observed in gestational trophoblastic diseases (GTD), such as a hydatidiform mole or a choriocarcinoma. However, the clinical symptoms of hyperthyroidism in GTD are rarely observed. A 27-years-old woman, admitted due to an amenorrhea of 11 weeks duration, with thyrotoxic symptoms, such as weight loss, palpitation, sweating, tremor, heat intolerance and anxiety, was evaluated. Her serum free T4 level was 8 times higher than normal, and her serum beta-HCG level was over 1,000,000IU/L. She had a curettage operation, with the pathological findings of a complete hydatidiform mole. These thyrotoxic symptoms developed due to a hydatidiform mole, and were accompanied with a highly increased serum beta-HCG level. After evacuation of the molar tissue, the thyroid hormone and thyrotoxic symptoms normalized. Here, this case is reported, with brief review of the literature.

The Efficacy of Thyroxine Suppression Therapy in Benign Thyroid Nodules.: Seog Ki Yun, Chul Hee Kim, Young Sun Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2000;15(4-5):532-541. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Benign pathologic findings are shown in 800% of thyroid nodules by fine needle aspiration cytology (FNAC) or needle biopsy. About half of these benign nodules are follicular lesions which are presented only as thyroid follicles or thyroid cell clumps. Differential diagnosis of follicular adenoma, follicular carcinoma and adenomatous goiter is impossible by FNAC or needle biopsy. Thyroxine suppression therapy has been performed traditionally in order to discriminate malignant nodules, but few studies are available which confirmed the efficacy of thyroxine suppression therapy in thyroid nodules of those the initial pathologic findings were follicular lesions. So we tried to evaluate the efficacy of thyroxine suppression therapy in benign thyroid nodules and also the incidence of thyroid cancer of the thyroid nosules which were not decreased on thyroxine suppression therapy after surgical resection. METHODS: Total 1027 patients with thyroid nodules were evaluated by FNAC or needle biopsy at Soonchunhyang university hospital from 1990 to 1996. Among 1027 patients, 507 patients showed follicular lesions in FNAC or needle biopsy and they received thyroxine suppression therapy. Thyroid nodule volume was measured before and after thyroxine suppression therapy using ultrasonography. We studied 184 patients who were followed up for more than 1 year. Serial changes of thyroid function tests, thyroid nodule volume, serum thyroglubulin (Tg) level before and after therapy were analyzed. RESULTS: l. In 80 (43.5%) of the 184 patients, nodule volumes decreased more than 50 percent after thyroxine suppression therapy. 2. There was no significant difference in serum T3, T4, TSH levels before and after thyroxine suppression therapy between group I (nodule volume decreased less than 50%) and group II (nodule volume decreased more than 50%). 3. In group II patients, thyroid nodule volumes were decreased continuously at 12 month, 18 month and 30 month after thyroxine suppression (p<0.05). 4. There was no significant difference between the group I and group II in the frequency of multiple thyroid nodules on ultrasonography. 5. Among 37 patients who underwent thyroidectomy, 19 cases (51.4%) were revealed as malignant thyroid nodules (papillary cancer 4 cases, follicular cancer 15 cases). Eighteen cases (48.6%) were revealed as benign thyroid nodules (follicular adenoma 10 cases, adenomatous goiter 8 cases). 6. There was no significant difference in the frequency of multiple nodules on ultrasonography between benign and malignant nodules. CONCLUSION: Our data suggested thyroxine suppression therapy was effective in discriminating malignant thyroid nodules from benign nodules, especially in selecting follicular carcinoma from follicular lesion by FNAC or biopsy.

A Case of Methimazole-Induced Cholestatic Jaundice with Steroid Therapy.: Wan Sup Kim, Jae Han Kim, Byung Ok Yoon, Young Min Kim, Sang Hun Song, Myoung Jin Oh, Heon Gyen Hwang, Chul Hee Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 1999;14(3):592-598. Published online January 1, 2001

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Abstract PDF: Cholestatic jaundice caused by imidazole derivatives is a rare complication of antithyroid drug therapy. We present a case of cholestatic jaundice with systemic hypersensitivity reaction, which developed in a 27-year old male one day after exposure to methimazole. The patient showed clinical improvement and gradual resolution of jaundice after the discontinuation of methimazole and treatment with prednisolone. Histologic findings of liver revealed bile pigment, predominantly in centrilobular area, and infiltration of chronic inflammatory cells in a few portal area without evidence of degeneration or necrosis of hepatocytes. Methimazole could be presumed as etiologic agent from clear chronological relationship and the lack of other causative factors. We report this unusual case with review of literature.

Surgical Findings of Benign Thyroid Nodule, Not Decreased After Thyroxine Suppression Therapy.: Dong Won Byun, Myung Hi Yoo, Kyo Il Suh, Hae Kyung Lee, Guk Bae Kim; J Korean Endocr Soc. 1996;11(4):401-408. Published online November 7, 2019

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Abstract PDF: Background
Fine needle aspiration and biopsy(FNAB) has known the most accurate test(about 90%) in the preoperative evaluation of patients with a thyroid nodule. The false negative findings of thyroid cancer by FNAB are mainly due to the aspiration of cystic fluid in cystic degeneration of thyroid cancer and the ipossibility of differentiation between follicular adenoma and carcinoma by aspiration or FNAB because of the failure to evaluate the capsule invasion or angioinvasion of the tumor. Actually more than 80% of the nodules are found as benign nodules in aspiration or FNAB and the findings of follieular lesions are found about half of the samples tested, so limiting the cancer incidence in surgically resected samples up to 50% of the surgical resection. Sa reasonable guidelines to manage the benign nodules on aspiration or FNAB are needed which can select the maligna~nt nodules with false negative findings on aspiration or FNAB. We tried to evaluate whether the thyroxine suppression therapy can increase the malignancy rates on thyroidectomy, Methods: We treated the benign thyroid nodules in FNAB with thyroxine for 1 year and cornpared the nodule volume change before and after treatment (every 6 month) with ultrasonogram. We performed thyroidectomy on 1~7 thyroid nodules wbich showed less than 50% decrease of nodule volume after 1 year of thyroxine suppression therapy. Results: The results were as follows. 1) Of all 17 patients, surgical resection revealed malignant thyroid nodule(Group I) in 10 cases (58.82%, papillary cancer. 6 cases, follicular cancer: 4 cases) and benign thyroid nodule(Group II) in 7 cases(41.18%, follicular adenoma: 4 cases, adenomatous goiter: 3 cases). 2) Between group I and II, there was no significant differences in serum T, T and TSH levels before and after thyroxine suppression therapy. Also, there were no significant difference in TSH suppression % between group I and group II(5.60+5.39%, 14.64+11.48%, respectively). 3) Thyroid nodule volume decrease percent before and after thyroxi~ne therapy showed no significant difference between group I and group II (124.80+54.18% vs 159.42+79.82%, p>0.05). Conclusion: Our data suggested that the benign thyroid nodules on aspiration or FNAB which were not suppressed in volume after thyroixine therapy revealed more than 50% incidence of malignancy on surgical resection, so these nodules were highly reeommended to surgical exploration.

Study on Restriction Fragment Length Polymorphisms of Vitamin - D Receptor Gene in relation to Bone Mineral Density and Bone Markers in Pre - and Postmenopausal Korean Women.: Myung Hee Yoo, Dong Won Byun, Kyo Il Suh, Guk Bae Kim, Sang Woo Kim, Ihn Gul Moon, In Kwon Han; J Korean Endocr Soc. 1994;10(3):249-261. Published online November 6, 2019

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Abstract PDF: Osteoporosis is now a major health problem because of the increasing elderly population and related osteoporosis fractures. Recently, it has been suggested that lower bone mass with/and high bone turnover rate is considered to be important in the developing of osteoporosis, and so there has been many efforts to identify the risk factors which is considered to cause lower bone mass and high bone turnover.Osteocalcin, the most abundant noncollagenous protein in bone, is a marker of bone turnover and its synthesis is induced by calcitriol(the active form of vitamine-D) through the vitamine-D receptor(VDR) and a specific vitamine D-responsive element in the osteocalcin gene promoter. Serum concentrations of osteocalcin are under the strong genetic influences and may reflect allelic variation in VDR gene. Therefore, the present study were designed to find the relationships among the polymorphisms of Vitamine-D receptor gene, bone mineral density and bone markers. We analysed the restriction fragment length polymorphisms of VDR gene with Bsm I endonuclease enzyme in relation to bone mineral density by using DEXA(dual energy X-ray absorptiometry, QDR-2000) and bone markers, especially serum osteocalcin concentrations in 356 pre- and postmenopausal Korean women.The frequence of RFLPs of VDR gene is 3.3% in BB type, 10.1% in Bb type, 86.6% in bb type. The concentrations of osteocalcin, alkaline phosphatase, procollagen-C and urinary deoxypyridinoline/creatinine were found to be higher in postmenopausal than premenopausal women and the levels of BMD were lower in postmenopausal than premenopausal women. The BB type, which is known to have a strong genetic determinant, is less frequently encountered in Korean women and does not correlate with levels of bone markers and bone mineral density. Even though the number of women with BB type is small, we noted the mean serum level of each bone marker was greater in postmenopausal women with BB type than in premenopausal women with the same genotype.In conclusion, this may suggest a partial agreement of our data with that of Australlian group and that we have to try to find out another genotype specifically related with lower bone density in Korean women.

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