Endocrinology and Metabolism

Review Article

Thyroid
Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers, Part II: Follow-up Surveillance after Initial Treatment 2026: Eun Kyung Lee, Seung Heon Kang, Bon Seok Koo, Mijin Kim, Min Joo Kim, Bo Hyun Kim, Ji Won Kim, Dong Gyu Na, Sohyun Park, Ji-In Bang, Kyorim Back, Youngduk Seo, Young-Ik Son, Young Shin Song, Dong Yeob Shin, Jong-hyuk Ahn, Hwa Young Ahn, So Won Oh, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Sang-Woo Lee, Jeongmin Lee, Ji Ye Lee, Dong-Jun Lim, Ki-Wook Chung, Ari Chong, Jin Hyang Jung, Sun Wook Cho, Yoon Young Cho, Chae Moon Hong, Young Joo Park, Korean Thyroid Association Guideline Committee on the Management of Thyroid Nodule and Cancer; Endocrinol Metab. 2026;41(4):493-534. Published online August 31, 2026; DOI: https://doi.org/10.3803/EnM.2026.3149

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In patients with differentiated thyroid cancer, initial recurrence-risk stratification based on clinical, histopathological, and perioperative findings remains central to management during the first 1–2 years after initial treatment. Ongoing risk stratification (ORS) complements this initial assessment by continuously integrating longitudinal clinical data and treatment response, thereby refining long-term prognostic assessment and supporting individualized risk-adapted management. Building on the 2024 Korean Thyroid Association (KTA) guidelines, the 2026 KTA guideline incorporates new evidence from large Korean multicenter cohorts and comprehensive systematic reviews. The updated recommendations reinforce the continued application of ORS and provide more specific guidance on risk-adapted thyroid-stimulating hormone (TSH) targets, surveillance strategies for recurrence detection, and long-term follow-up tailored to individual recurrence risk and treatment response. Consistent with the evolving paradigm toward risk-adapted and individualized management, this revision updates recommendations regarding target serum TSH levels, serum thyroglobulin thresholds for response assessment and long-term surveillance, and follow-up intervals based on both initial-risk category and the ORS response category. These evidence-based recommendations aim to minimize unnecessary treatment and excessive surveillance in the majority of patients who have an excellent prognosis after initial therapy while ensuring individualized long-term management for patients who require closer surveillance or additional therapeutic intervention.

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Postoperative Surveillance in Differentiated Thyroid Cancer: Response-Adapted De-Escalation in the 2025 American Thyroid Association and 2026 Korean Thyroid Association Guidelines
Sun Wook Cho
Endocrinology and Metabolism.2026; 41(4): 535. CrossRef

Response

Thyroid
Study Protocol of Expanded Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro-EXP) (Endocrinol Metab 2025;40:236-46, Jae Hoon Moon et al.): Eun Kyung Lee, Jae Hoon Moon, Young Joo Park; Endocrinol Metab. 2025;40(4):655-656. Published online July 23, 2025; DOI: https://doi.org/10.3803/EnM.2025.2495

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Review Articles

Thyroid
The Initial Risk Stratification System for Differentiated Thyroid Cancer: Key Updates in the 2024 Korean Thyroid Association Guideline: Shinje Moon, Young Shin Song, Kyong Yeun Jung, Eun Kyung Lee, Jeongmin Lee, Dong-Jun Lim, Chan Kwon Jung, Young Joo Park, on Behalf of the Korean Thyroid Association Clinical Guideline Committee; Endocrinol Metab. 2025;40(3):357-384. Published online June 24, 2025; DOI: https://doi.org/10.3803/EnM.2025.2465

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In 2024, the Korean Thyroid Association (KTA) introduced a revised Risk Stratification System (K-RSS) for differentiated thyroid cancer, building upon the modified RSS (M-RSS) proposed by the American Thyroid Association in 2015. The K-RSS emphasizes the cumulative impact of coexisting clinical and pathological features, acknowledging that multiple intermediate-risk factors collectively indicate a higher recurrence risk. Histologic classification follows the 2022 World Health Organization classification, consolidating encapsulated follicular-patterned thyroid carcinomas, including invasive encapsulated follicular variant papillary thyroid carcinoma, follicular thyroid carcinoma, and oncocytic carcinoma of the thyroid gland, and stratifying them by the extent of capsular and vascular invasion. High-grade thyroid carcinoma is newly included. Updated criteria for tumor size and extrathyroidal extension (ETE) represent another significant change. BRAF^V600E-mutated papillary thyroid carcinomas measuring 1 to 2 cm are now considered lower risk than previously classified in the M-RSS, while encapsulated follicular-patterned tumors larger than 4 cm are considered higher risk. Both minimal ETE and gross ETE confined to the strap muscles have been downgraded to low and intermediate risk, respectively. These changes are accompanied by updates regarding molecular profiling and surgical margin status. Collectively, these updates aim to minimize overtreatment in low-risk patients, while ensuring intensified management for those at higher risk.

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Thyroglobulin Cutoffs after Total Thyroidectomy Without Radioiodine in Low- to Intermediate-Risk Thyroid Cancer: A Multicenter Cohort Study
Mijin Kim, Eun Kyung Lee, Kyeong Jin Kim, Soo Myoung Shin, Jinsun Jang, Je Yoon Shin, Meihua Jin, Ja Seong Bae, Kwangsoon Kim, Won Gu Kim, Min Ji Jeon, Seung Heon Kang, Hee Kyung Kim, Jee Hee Yoon, Yea Eun Kang, Hwa Young Ahn, Young Joo Park, Bo Hyun Kim
Thyroid®.2026; 36(1): 46. CrossRef
Development and validation of a machine learning model for predicting high-risk distant metastatic recurrence in differentiated thyroid cancer
Fei Yang, Jie Zhang, Tengfei Liu, Zhijun Zhao
Frontiers in Medicine.2026;[Epub] CrossRef
Impact of Tumor Bilaterality and Multifocality in Predicting Recurrence of Papillary Thyroid Carcinoma: A Retrospective Cohort Study
Eunji Kim, Jun Hyun Park, Ji-Young Park, Jin Hyang Jung, Sang-Woo Lee
Endocrinology and Metabolism.2026; 41(2): 288. CrossRef
Positive prognostic implications of SPHK1 expression in patients with papillary thyroid carcinoma undergoing radioactive iodine therapy
Kyung Won Park, Ja Seong Bae, Dong-Jun Lim, Chan Kwon Jung
Scientific Reports.2026;[Epub] CrossRef
Overdiagnosis and Overtreatment of Thyroid Cancer and Precision Mitigation Strategies—An Integrated Analysis Based on Evidence-Based Medicine and Risk Stratification Models
云菲李
Advances in Clinical Medicine.2026; 16(04): 4980. CrossRef
Clinicopathological profile of high-grade differentiated thyroid carcinoma in an Indonesian tertiary hospital
Novita, Agnes Stephanie Harahap, Maria Francisca Ham, Alfianto Widiono, Chan Kwon Jung
Journal of Pathology and Translational Medicine.2026; 60(3): 338. CrossRef
ATA 2015-2025 risk stratification transition: prognostic significance of N1b disease in papillary thyroid carcinoma with limited nodal burden
Ziqiang Wang, Yangyang Xie, Tingting Wang, Danwei Du, Xue Song
The Oncologist.2026;[Epub] CrossRef
Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part II. Follow-up Surveillance after Initial Treatment 2026
Eun Kyung Lee, Seung Heon Kang, Bon Seok Koo, Mijin Kim, Min Joo Kim, Bo Hyun Kim, Ji Won Kim, Dong Gyu Na, Sohyun Park, Ji-In Bang, Kyorim Back, Youngduk Seo, Young-Ik Son, Young Shin Song, Dong Yeob Shin, Jong-Hyuk Ahn, Hwa Young Ahn, So Won Oh, Ho-Ryun
International Journal of Thyroidology.2026; 19(1): 1. CrossRef
Evolution of Follow-up Strategies in Differentiated Thyroid Cancer: a Comparative Review of the 2015 ATA, 2024 KTA, and 2025 ATA Guidelines
Mijin Kim, Bo Hyun Kim
International Journal of Thyroidology.2026; 19(1): 41. CrossRef
From Risk Categories to Risk-Adapted Care: Comparing the 2025 American Thyroid Association and 2024 Korean Thyroid Association Risk Stratification Systems in Differentiated Thyroid Cancer
Won Gu Kim, Mijin Kim
Endocrinology and Metabolism.2026; 41(3): 383. CrossRef
Value of TERT promoter mutations for early outcomes in papillary thyroid cancer
Min Jhi Kim, Daham Kim, Hye Sun Lee, Se Hee Park, Eun Jin Kim, Jin Kyong Kim, Sang-Wook Kang, Jandee Lee, Jong Ju Jeong, Woong Youn Chung, Kee-Hyun Nam
Endocrine-Related Cancer.2026;[Epub] CrossRef
Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers, Part II: Follow-up Surveillance after Initial Treatment 2026
Eun Kyung Lee, Seung Heon Kang, Bon Seok Koo, Mijin Kim, Min Joo Kim, Bo Hyun Kim, Ji Won Kim, Dong Gyu Na, Sohyun Park, Ji-In Bang, Kyorim Back, Youngduk Seo, Young-Ik Son, Young Shin Song, Dong Yeob Shin, Jong-hyuk Ahn, Hwa Young Ahn, So Won Oh, Ho-Ryun
Endocrinology and Metabolism.2026; 41(4): 493. CrossRef
Who Really Needs RAI Ablation Therapy for Low-to-Intermediate Risk Differentiated Thyroid Cancer? Insights from the IoN Trial
Young Joo Park
Clinical Thyroidology®.2025; 37(9): 323. CrossRef
From Classification to Personalization: Advances in Thyroid Cancer Risk Stratification Systems
Mijin Kim, Bo Hyun Kim
Endocrinology and Metabolism.2025; 40(5): 689. CrossRef
Diagnostic Challenges, Prognostic Assessment, and Treatment Strategies in High-Grade Differentiated Thyroid Carcinoma
Chan Kwon Jung, Agnes Stephanie Harahap
Endocrinology and Metabolism.2025; 40(6): 830. CrossRef

Thyroid
2025 Korean Thyroid Association Management Guidelines for Radioactive Iodine Therapy in Patients with Hyperthyroidism: Kyeong Jin Kim, Eyun Song, Mijin Kim, Hyemi Kwon, Eu Jeong Ku, Hyun Woo Kwon, Jee Hee Yoon, Eun Kyung Lee, Won Woo Lee, Young Joo Park, Dong-Jun Lim, Sun Wook Kim, Ho-Cheol Kang, Jae Hoon Chung, Tae Yong Kim, Sin Gon Kim, Dong Gyu Na, Jee Soo Kim; Endocrinol Metab. 2025;40(3):342-356. Published online June 24, 2025; DOI: https://doi.org/10.3803/EnM.2025.2464

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Hyperthyroidism is a condition marked by excessive thyroid hormone production, most commonly due to Graves’ disease. Treatment options include antithyroid drugs (ATD), radioactive iodine (RAI) therapy, and thyroidectomy. To develop standardized clinical recommendations for RAI therapy with a focus on safety, efficacy, and monitoring, the Korean Thyroid Association formed a task force to create evidence-based guidelines. Six key clinical questions were identified through expert consensus, and a systematic literature review from 2013 to 2022 was conducted. Clinical indications for RAI therapy were categorized into three groups: strongly recommended, may be considered, and not recommended. A fixed dose of 10 to 15 mCi is recommended. Although a strict low-iodine diet is unnecessary, iodine-rich foods should be avoided for at least 1 week before treatment. ATD should be stopped 3 to 7 days before RAI and may be resumed in select cases. Prophylactic glucocorticoids are recommended for patients with mildly active thyroid eye disease and may be considered for others at risk. Thyroid function should be monitored at 4–6 weeks post-treatment, every 2–3 months until stabilized, and then every 6–12 months. These guidelines highlight recent advances and underscore the importance of individualized treatment based on clinical features, comorbidities, and patient preferences in Korea.

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Outcome of MRI-Guided Single-Dose Iodine-131 for Graves’ Hyperthyroidism with Large Goiter
Shangcheng Yan, Xiansheng Chen, Bing Yan, Xin Li, Zhen Cao, Pan Zhang, Yajun Wang, Wenmei Guo, Ziwen Liu
Annals of Nuclear Medicine.2026; 40(6): 624. CrossRef
From Patient Selection to Surveillance: Artificial Intelligence Applications in Radioiodine Therapy – A Systematic Review
Maria Obrycka, Saeid Abdelrazek, Łukasz Żukowski, Janusz Myśliwiec, Piotr Szumowski
Nuclear Medicine and Molecular Imaging.2026; 60(5): 490. CrossRef

Thyroid
2025 Korean Thyroid Association Clinical Management Guideline on Active Surveillance for Low-Risk Papillary Thyroid Carcinoma: Eun Kyung Lee, Min Joo Kim, Seung Heon Kang, Bon Seok Koo, Kyungsik Kim, Mijin Kim, Bo Hyun Kim, Ji-hoon Kim, Shinje Moon, Kyorim Back, Young Shin Song, Jong-hyuk Ahn, Hwa Young Ahn, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Jeongmin Lee, Ji Ye Lee, Kyong Yeun Jung, Chan Kwon Jung, Yoon Young Cho, Dong-Jun Lim, Sun Wook Kim, Young Joo Park, Dong Gyu Na, Jee Soo Kim; Endocrinol Metab. 2025;40(3):307-341. Published online June 24, 2025; DOI: https://doi.org/10.3803/EnM.2025.2461

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The increasing detection of papillary thyroid microcarcinoma (PTMC) has raised concerns regarding overtreatment. For low-risk PTMC, either immediate surgery or active surveillance (AS) can be considered. To facilitate the implementation of AS, the Korean Thyroid Association convened a multidisciplinary panel and developed the first Korean guideline. AS is recommended for adults with pathologically confirmed Bethesda V–VI PTMC who have no clinical evidence of lymph node or distant metastasis, gross extrathyroidal extension, invasion of the trachea or recurrent laryngeal nerve, or aggressive histology. A baseline assessment requires high-resolution neck ultrasound performed by experienced operators to exclude extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, and lymph node metastasis; contrast-enhanced neck computed tomography is optional. Patient characteristics, including age, comorbidities, and the capacity for long-term follow-up, should be thoroughly assessed. Shared decision-making should carefully weigh the benefits and risks of surgery versus AS, considering expected oncologic outcomes, potential complications, quality of life, anxiety, medical costs, and patient preference. Follow-up involves neck ultrasound and thyroid function tests every 6 months for 2 years and annually thereafter. Disease progression, defined as significant tumor growth or newly detected nodal or distant metastasis, warrants surgery. Despite remaining uncertainties, this guideline provides a structured framework to ensure oncologic safety and supports patient-centered AS.

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Feasibility and Safety of Active Surveillance in Subcapsular Thyroid Nodules with High Suspicion for Malignancy
Yan Hu, Wei Zhou, Lu Zhang, Weiwei Zhan
Ultrasound in Medicine & Biology.2026; 52(4): 816. CrossRef
Combined Ultrasound and MRI Assessment in Patients Undergoing Reoperation for Recurrent Papillary Thyroid Carcinoma: Oncological Outcomes and Surgical Safety
Zimei Tang, Jie Liu, Rong Wang, Gang Tian, Anwen Ren, Jiexiao Li, Yiran Wang, Wen Yang, Peng Sun, Tao Huang, Ximeng Zhang, Jie Ming
Current Oncology.2026; 33(2): 98. CrossRef
Multidisciplinary team diagnosis and treatment of well-differentiated thyroid carcinoma: current landscape and future prospects
Yuanyuan Li, Peijie Wang, Jiaxin Cao, Haiyan Liu
The Oncologist.2026;[Epub] CrossRef
Controlled minimally invasive surgical interventions for the treatment of patients with thyroid carcinoma
David D. Dolidze, Zurab A. Bagatelia, Suren G. Laboyan, Arshak V. Vardanyan, Konstantin S. Titov, Ivan N. Lebedinsky, Georgi Genadi Melkonyan, Dmitriy V. Matveev, Nodar N. Gogitidze, Andrei Y. Lukin, Armen R. Oganyan, David G. Gogolashvili, Anastasia V. B
Journal of Experimental and Clinical Surgery.2026; 19(1): 45. CrossRef
Overdiagnosis and Overtreatment of Thyroid Cancer and Precision Mitigation Strategies—An Integrated Analysis Based on Evidence-Based Medicine and Risk Stratification Models
云菲李
Advances in Clinical Medicine.2026; 16(04): 4980. CrossRef
Active surveillance for low-risk papillary thyroid carcinoma: Integrating guidelines, emerging evidence, and directions
Zijing Wu, Kaiang Zhang, Huixian Zhou, Leyi Wan, Jingyuan Zhong, Chunhua Li, Lianggeng Gong, Yun Peng
iScience.2026; 29(6): 115832. CrossRef
Prognostic Factors and Recurrence in Papillary Thyroid Microcarcinoma
Aydan Farzaliyeva, Feride Pınar Altay, Ozlem Turhan Iyidir, Neslihan Bascil Tutuncu
Medicina.2026; 62(5): 981. CrossRef
Response to “Balancing Sensitivity and Overtreatment in Preoperative CT Evaluation for Papillary Thyroid Microcarcinoma”
Young Hun Jeon, Ji Ye Lee
Korean Journal of Radiology.2026; 27(9): 908. CrossRef
A novel cartilage-based reference point for the recurrent laryngeal nerve: implication for preoperative risk stratification in posterior subcapsular thyroid tumors
Qianqian Lu, Feiliang Wang, Xiaoquan Zhu, Jiankun Li, Weijing Li, Dongdong Wang, Yao Li, Yanyang Zhao, Gang Miao
World Journal of Surgical Oncology.2026;[Epub] CrossRef
Risk factors associated with lymph node metastasis in cN0 papillary thyroid microcarcinoma
Shijie Zheng, Chuangwu Ke, Weijing Hao, Xiaohan Chen, Wenchao Zhang
Frontiers in Oncology.2026;[Epub] CrossRef
Papillary thyroid carcinoma in a patient with long‑standing chronic lymphocytic leukemia: A case report
Jiaxiang Ma, Tieying Gan, Ailin Song, Hongyou Tian, Shaoce Xu, Lei Zhao
Oncology Letters.2026; 32(4): 1. CrossRef
Prediction of Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma Using a Deep Learning Radiomics Model Based on SAM3 Automatic Segmentation of Ultrasound Images: A Multicenter Cohort Study
Jun Song, Yuan Zhang, Xiachuan Qin, Xiaoling Liu, Fanding He
Academic Radiology.2026;[Epub] CrossRef
Radiofrequency Ablation of Calcified Papillary Thyroid Microcarcinoma: Long-Term Imaging Evolution and Clinical Outcomes
So Yeong Jeong, Sun Mi Baek, Suyoung Shin, Hyunsoo Kim, Young Hwa Suh, Jung Hwan Baek
Thyroid®.2026;[Epub] CrossRef
Optimal cutoff value of fine-needle aspiration thyroglobulin of metastatic lymph node in thyroid cancer patients
Yang Yang, Xianfeng Jiang
European Journal of Surgical Oncology.2025; 51(11): 110428. CrossRef
Low-risk thyroid cancer: surgery or active surveillance—an application of shared decision-making: a narrative review
Min Joo Kim, Eun Kyung Lee, Sun Wook Cho, Yoo Hyung Kim, Kyu Eun Lee, Su-jin Kim, Woochul Kim, Eun-Jae Chung, Jungirl Seok, Yul Hwangbo, Young Ki Lee, Jinsun Jang, Junsun Ryu, Yuh-Seog Jung, Chang Hwan Ryu, Jae Hoon Moon, June Young Choi, Hyeong Won Yu, K
Journal of the Korean Medical Association.2025; 68(9): 573. CrossRef

Original Articles

Thyroid
Study Protocol of Expanded Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro-EXP): Jae Hoon Moon, Eun Kyung Lee, Wonjae Cha, Young Jun Chai, Sun Wook Cho, June Young Choi, Sung Yong Choi, A Jung Chu, Eun-Jae Chung, Yul Hwangbo, Woo-Jin Jeong, Yuh-Seog Jung, Kyungsik Kim, Min Joo Kim, Su-jin Kim, Woochul Kim, Yoo Hyung Kim, Chang Yoon Lee, Ji Ye Lee, Kyu Eun Lee, Young Ki Lee, Hunjong Lim, Do Joon Park, Sue K. Park, Chang Hwan Ryu, Junsun Ryu, Jungirl Seok, Young Shin Song, Ka Hee Yi, Hyeong Won Yu, Eleanor White, Katerina Mastrocostas, Roderick J. Clifton-Bligh, Anthony Glover, Matti L. Gild, Ji-hoon Kim, Young Joo Park; Endocrinol Metab. 2025;40(2):236-246. Published online February 18, 2025; DOI: https://doi.org/10.3803/EnM.2024.2136

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Background
Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making.
Methods
This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes.
Conclusion
This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Citations

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Shared Decision-Making for Determining Treatment Strategies in Low-Risk Thyroid Cancer: Protocol of a Multicenter Cluster-Randomized Trial (MAeSTro-SDM)
Eun Kyung Lee, Min Joo Kim, Yul Hwangbo, Jae Hoon Moon, Sun Wook Cho, Young Jun Chai, June Young Choi, Yuh-Seog Jung, Kyu Eun Lee, Eun-Jae Chung, Kyungsik Kim, Su-jin Kim, Woochul Kim, Yoo Hyung Kim, Young Ki Lee, Jinsun Jang, Young Shin Song, Ka Hee Yi,
Journal of Korean Medical Science.2026;[Epub] CrossRef
Diagnostic dilemma in active surveillance of papillary thyroid microcarcinoma: A case of vagus nerve schwannoma misdiagnosed as lymph node metastasis
Ling Zhao, Fengwu Yang, Jie Deng, Wen Zhang
Asian Journal of Surgery.2026;[Epub] CrossRef
Study Protocol of Expanded Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro-EXP) (Endocrinol Metab 2025;40:236-46, Jae Hoon Moon et al.)
Eun Kyung Lee, Jae Hoon Moon, Young Joo Park
Endocrinology and Metabolism.2025; 40(4): 655. CrossRef
Study Protocol of Expanded Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro-EXP) (Endocrinol Metab 2025;40:236-46, Jae Hoon Moon et al.)
Hoonsung Choi
Endocrinology and Metabolism.2025; 40(4): 653. CrossRef
Habitat imaging combined with multimodal analysis for preoperative risk stratification of papillary thyroid carcinoma
Jia-Wei Feng, You-Long Zhu, Lu Zhang, Yu-Xin Yang, An-Cheng Qin, Shui-Qing Liu, Yong Jiang
Insights into Imaging.2025;[Epub] CrossRef

Thyroid Big Data Articles (National Health Insurance Service Database)
Risk of Osteoporotic Fractures among Patients with Thyroid Cancer: A Nationwide Population-Based Cohort Study: Eu Jeong Ku, Won Sang Yoo, Yu Been Hwang, Subin Jang, Jooyoung Lee, Shinje Moon, Eun Kyung Lee, Hwa Young Ahn; Endocrinol Metab. 2025;40(2):225-235. Published online January 15, 2025; DOI: https://doi.org/10.3803/EnM.2024.2101

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Background
The associations between thyroid cancer and skeletal outcomes have not been thoroughly investigated. We aimed to investigate the risk of osteoporotic fractures in patients with thyroid cancer compared to that in a matched control group.
Methods
This retrospective cohort study included 2,514 patients with thyroid cancer and 75,420 matched controls from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC, 2006–2019). The rates of osteoporotic fractures were analyzed, and associations with the levothyroxine dose were evaluated.
Results
Patients with thyroid cancer had a significantly lower risk of fracture than did the control group (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.69 to 0.94; P=0.006). Patients diagnosed with thyroid cancer after the age of 50 years (older cancer group) had a significantly lower risk of fracture than did those in the control group (HR, 0.72; 95% CI, 0.6 to 0.85; P<0.001), especially those diagnosed with spinal fractures (HR, 0.66; 95% CI, 0.51 to 0.85; P=0.001). Patients in the older cancer group started osteoporosis treatment earlier than did those in the control group (65.5±7.5 years vs. 67.3±7.6 years, P<0.001). Additionally, a lower dose of levothyroxine was associated with a reduced risk of fractures.
Conclusion
In the clinical setting, the risk of fracture in women diagnosed with thyroid cancer after the age of 50 years was lower than that in the control group, which was caused by more proactive osteoporosis treatment in postmenopausal women with thyroid cancer.

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Increased risk of osteoporosis among thyroid cancer survivors: the influence of postoperative levothyroxine therapy in a nationwide cohort study
Young Bin Cho, Kyoung Sik Park
Annals of Surgical Treatment and Research.2026; 110(2): 84. CrossRef
A Comparative Evaluation of Three Time-to-Event Models Predicting 5-Year Osteoporosis Risk in Thyroid Cancer Survivors: A Nationwide Cohort Study
Young Bin Cho, Kyoung Sik Park
Endocrinology and Metabolism.2026; 41(1): 174. CrossRef
Japanese cancer survivors have a higher risk of fragility fractures over ten years
Takaomi Kobayashi, Yuichiro Nishida, Takuma Furukawa, Chisato Shimanoe, Mikako Horita, Hinako Nanri, Yasuki Higaki, Tadatsugu Morimoto, Keitaro Tanaka, Megumi Hara
Scientific Reports.2026;[Epub] CrossRef
Assessing the risk of osteoporotic fracture recurrence using CT-based radiomics and machine learning
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Current Problems in Surgery.2025; 72: 101876. CrossRef
Prospective evidence for the gut–bone axis in osteoporotic fractures: Insights from genetic prediction and metabolite mediators
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Bone.2025; 201: 117651. CrossRef

Review Articles

Thyroid
Active Surveillance for Low-Risk Thyroid Cancers: A Review of Current Practice Guidelines: Min Joo Kim, Jae Hoon Moon, Eun Kyung Lee, Young Shin Song, Kyong Yeun Jung, Ji Ye Lee, Ji-hoon Kim, Kyungsik Kim, Sue K. Park, Young Joo Park; Endocrinol Metab. 2024;39(1):47-60. Published online February 15, 2024; DOI: https://doi.org/10.3803/EnM.2024.1937

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The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing lowrisk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.

Citations

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Active Surveillance for Locoregional Recurrent Differentiated Thyroid Cancer: A Systematic Review and Meta-Analysis
Hunjong Lim, Se Jin Cho, Jung Hwan Baek
Thyroid®.2026; 36(2): 121. CrossRef
Shared Decision-Making for Determining Treatment Strategies in Low-Risk Thyroid Cancer: Protocol of a Multicenter Cluster-Randomized Trial (MAeSTro-SDM)
Eun Kyung Lee, Min Joo Kim, Yul Hwangbo, Jae Hoon Moon, Sun Wook Cho, Young Jun Chai, June Young Choi, Yuh-Seog Jung, Kyu Eun Lee, Eun-Jae Chung, Kyungsik Kim, Su-jin Kim, Woochul Kim, Yoo Hyung Kim, Young Ki Lee, Jinsun Jang, Young Shin Song, Ka Hee Yi,
Journal of Korean Medical Science.2026;[Epub] CrossRef
Feasibility and Safety of Active Surveillance in Subcapsular Thyroid Nodules with High Suspicion for Malignancy
Yan Hu, Wei Zhou, Lu Zhang, Weiwei Zhan
Ultrasound in Medicine & Biology.2026; 52(4): 816. CrossRef
Radiofrequency Ablation for Primary Thyroid Cancer
Iram Hussain
Endocrine Practice.2026;[Epub] CrossRef
De-escalation strategies in the management of differentiated thyroid cancer
Mubeen Hussein Arawker, Fitrat Habibullah, Shantanu Baral, Lijun Fu, Ning Sun, Hongting Li, Xinguang Qiu
Endocrine.2026;[Epub] CrossRef
Current Challenges in Imaging-Based Cancer Screening, From the AJR Special Series on Screening
Lars J. Grimm, Danielle E. Kruse, Tina D. Tailor, Karen S. Johnson, Brian C. Allen, Marc D. Ryser
American Journal of Roentgenology.2026;[Epub] CrossRef
Controlled minimally invasive surgical interventions for the treatment of patients with thyroid carcinoma
David D. Dolidze, Zurab A. Bagatelia, Suren G. Laboyan, Arshak V. Vardanyan, Konstantin S. Titov, Ivan N. Lebedinsky, Georgi Genadi Melkonyan, Dmitriy V. Matveev, Nodar N. Gogitidze, Andrei Y. Lukin, Armen R. Oganyan, David G. Gogolashvili, Anastasia V. B
Journal of Experimental and Clinical Surgery.2026; 19(1): 45. CrossRef
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Thyroid
A Narrative Review of the 2023 Korean Thyroid Association Management Guideline for Patients with Thyroid Nodules: Eun Kyung Lee, Young Joo Park, Chan Kwon Jung, Dong Gyu Na; Endocrinol Metab. 2024;39(1):61-72. Published online February 14, 2024; DOI: https://doi.org/10.3803/EnM.2024.1938

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The 2023 Korean Thyroid Association (KTA) Management Guideline for Patients with Thyroid Nodules constitute an update of the 2016 KTA guideline for thyroid nodules and cancers that focuses specifically on nodules. The 2023 guideline aim to offer updated guidance based on new evidence that reflects the changes in clinical practice since the 2016 KTA guideline. To update the 2023 guideline, a comprehensive literature search was conducted from January 2022 to May 2022. The literature search included studies, reviews, and other evidence involving human subjects that were published in English in MEDLINE (PubMed), Embase, and other relevant databases. Additional significant clinical trials and research studies published up to April 2023 were also reviewed. The limitations of the current evidence are discussed, and suggestions for areas in need of further research are identified. The purpose of this review is to provide a summary of the 2023 KTA guideline for the management of thyroid nodules released in May 2023 and to give a balanced insight with comparison of recent guidelines from other societies.

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Original Articles

Miscellaneous
Incidence of Endocrine-Related Dysfunction in Patients Treated with New Immune Checkpoint Inhibitors: A Meta-Analysis and Comprehensive Review: Won Sang Yoo, Eu Jeong Ku, Eun Kyung Lee, Hwa Young Ahn; Endocrinol Metab. 2023;38(6):750-759. Published online November 13, 2023; DOI: https://doi.org/10.3803/EnM.2023.1785

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Background
This study investigated the incidence of endocrine immune-related adverse events (irAEs) for recently developed immune checkpoint inhibitor (ICI) drugs.
Methods
We collected studies on newly developed ICI drugs using PubMed/Medline, Embase, and Cochrane Library from inception through January 31, 2023. Among ICI drugs, nivolumab, pembrolizumab, and ipilimumab were excluded from the new ICI drugs because many papers on endocrine-related side effects have already been published.
Results
A total of 44,595 patients from 177 studies were included in this analysis. The incidence of hypothyroidism was 10.1% (95% confidence interval [CI], 8.9% to 11.4%), thyrotoxicosis was 4.6% (95% CI, 3.8% to 5.7%), hypophysitis was 0.8% (95% CI, 0.5% to 1.1%), adrenal insufficiency was 0.9% (95% CI, 0.7% to 1.1%), and hyperglycemia was 2.3% (95% CI, 1.6% to 3.4%). Hypothyroidism and thyrotoxicosis occurred most frequently with programmed cell death protein-1 (PD-1) inhibitors (13.7% and 7.5%, respectively). The rate of endocrine side effects for the combination of a programmed death-ligand 1 inhibitor (durvalumab) and cytotoxic T lymphocyte-associated antigen 4 inhibitor (tremelimumab) was higher than that of monotherapy. In a meta-analysis, the combination of tremelimumab and durvalumab had a 9- to 10-fold higher risk of pituitary and adrenal-related side effects than durvalumab alone.
Conclusion
Newly developed PD-1 inhibitors had a high incidence of thyroid-related irAEs, and combined treatment with durvalumab and tremelimumab increased the risk of pituitary- and adrenal-related irAEs. Based on these facts, it is necessary to predict the endocrine side effects corresponding to each ICI drug, diagnose and treat them appropriately, and try to reduce the morbidity and mortality of patients.

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Thyroid Thyroid Cancer Screening
Survival Comparison of Incidentally Found versus Clinically Detected Thyroid Cancers: An Analysis of a Nationwide Cohort Study: Shinje Moon, Eun Kyung Lee, Hoonsung Choi, Sue K. Park, Young Joo Park; Endocrinol Metab. 2023;38(1):81-92. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2023.1668

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Background
The true benefit of thyroid cancer screening is incompletely understood. This study investigated the impact of ultrasound screening on thyroid cancer outcomes through a comparison with symptomatic thyroid cancer using data from a nationwide cohort study in Korea.
Methods
Cox regression analysis was performed to assess the hazard ratios (HRs) for all-cause and thyroid cancer-specific mortality. Considering the possible bias arising from age, sex, year of thyroid cancer registration, and confounding factors for mortality (including smoking/drinking status, diabetes, and hypertension), all analyses were conducted with stabilized inverse probability of treatment weighting (IPTW) according to the route of detection.
Results
Of 5,796 patients with thyroid cancer, 4,145 were included and 1,651 were excluded due to insufficient data. In comparison with the screening group, the clinical suspicion group was associated with large tumors (17.2±14.6 mm vs. 10.4±7.9 mm), advanced T stage (3–4) (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09 to 1.41), extrathyroidal extension (OR, 1.16; 95% CI, 1.02 to 1.32), and advanced stage (III–IV) (OR, 1.16; 95% CI, 1.00 to 1.35). In IPTW-adjusted Cox regression analysis, the clinical suspicion group had significantly higher risks of all-cause mortality (HR, 1.43; 95% CI, 1.14 to 1.80) and thyroid cancer-specific mortality (HR, 3.07; 95% CI, 1.77 to 5.29). Mediation analysis showed that the presence of thyroid-specific symptoms was directly associated with a higher risk of cancer-specific mortality. Thyroid-specific symptoms also indirectly affected thyroid cancer-specific mortality, mediated by tumor size and advanced clinicopathologic status.
Conclusion
Our findings provide important evidence for the survival benefit of early detection of thyroid cancer compared to symptomatic thyroid cancer.

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Thyroid cancer in Asia: incidence, mortality in 2022, and future projections to 2050
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Clinical Characteristics and Outcomes of Clinically Detected Versus Imaging-Detected Incidental Thyroid Cancer
Po-Sheng Lee, Chi-Lung Tseng, Jui-Yu Chen, Harn-Shen Chen, Chun-Jui Huang
Endocrine Practice.2026; 32(5): 769. CrossRef
Medullary Thyroid Carcinoma Detected by Routine Health Screening Had Better Clinical Outcome and Survival
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A One-Year Cross-Sectional Study on the Impact of the Thyroid Imaging Reporting and Data System (TIRADS) on Fine-Needle Aspiration Cytology (FNAC) Decision-Making in a Secondary Care Hospital
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Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population
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Thyroid cancer-specific mortality during 2005–2018 in Korea, aftermath of the overdiagnosis issue: a nationwide population-based cohort study
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Distinct Impacts of Clinicopathological and Mutational Profiles on Long-Term Survival and Recurrence in Medullary Thyroid Carcinoma
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Clinical Characteristics, Diagnostic Approach and Outcome of Thyroid Incidental Findings vs. Clinically Overt Thyroid Nodules: An Observational Single-Centre Study
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Lower Thyroid Cancer Mortality in Patients Detected by Screening: A Meta-Analysis
Shinje Moon, Young Shin Song, Kyong Yeun Jung, Eun Kyung Lee, Young Joo Park
Endocrinology and Metabolism.2023; 38(1): 93. CrossRef
To Screen or Not to Screen?
Do Joon Park
Endocrinology and Metabolism.2023; 38(1): 69. CrossRef
The 2017 United States Preventive Services Task Force Recommendation for Thyroid Cancer Screening Is No Longer the Gold Standard
Ka Hee Yi
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Thyroid Thyroid Cancer Screening
Lower Thyroid Cancer Mortality in Patients Detected by Screening: A Meta-Analysis: Shinje Moon, Young Shin Song, Kyong Yeun Jung, Eun Kyung Lee, Young Joo Park; Endocrinol Metab. 2023;38(1):93-103. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2023.1667

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Background
Thyroid cancer screening has contributed to the skyrocketing prevalence of thyroid cancer. However, the true benefit of thyroid cancer screening is not fully understood. This study aimed to evaluate the impact of screening on the clinical outcomes of thyroid cancer by comparing incidental thyroid cancer (ITC) with non-incidental thyroid cancer (NITC) through a meta-analysis.
Methods
PubMed and Embase were searched from inception to September 2022. We estimated and compared the prevalence of high-risk features (aggressive histology of thyroid cancer, extrathyroidal extension, metastasis to regional lymph nodes or distant organs, and advanced tumor-node-metastasis [TNM] stage), thyroid cancer-specific death, and recurrence in the ITC and NITC groups. We also calculated pooled risks and 95% confidence intervals (CIs) of the outcomes derived from these two groups.
Results
From 1,078 studies screened, 14 were included. In comparison to NITC, the ITC group had a lower incidence of aggressive histology (odds ratio [OR], 0.46; 95% CI, 0.31 to 0.7), smaller tumors (mean difference, −7.9 mm; 95% CI, −10.2 to −5.6), lymph node metastasis (OR, 0.64; 95% CI, 0.48 to 0.86), and distant metastasis (OR, 0.42; 95% CI, 0.23 to 0.77). The risks of recurrence and thyroid cancer-specific mortality were also lower in the ITC group (OR, 0.42; 95% CI, 0.25 to 0.71 and OR, 0.46; 95% CI, 0.28 to 0.74) than in the NITC group.
Conclusion
Our findings provide important evidence of a survival benefit from the early detection of thyroid cancer compared to symptomatic thyroid cancer.

Citations

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Overdiagnosis of thyroid cancer in the United States: Improved estimates based on the SEER registries during 2000–2019
Minlu Zhang, Dongchen Xie, Yi Hu, Guoyou Qin, Wanghong Xu
International Journal of Cancer.2026; 158(5): 1215. CrossRef
A guide to cancer screening
Stephen W. Duffy, Judith Offman
Nature Reviews Clinical Oncology.2026; 23(3): 201. CrossRef
Spatial-temporal epidemiological characteristics of thyroid cancer mortality in China cancer registration areas: analysis based on multiple models
Jiaqi Yang, Zhenhao Zheng, Jianjiang Shao, Yueze Gong, Yu Zhang, Han Wang, Yunhua Hu, Hao Liu, Wen Liu, Yizhong Yan
Frontiers in Oncology.2026;[Epub] CrossRef
Radioactive Iodine in Differentiated Thyroid Cancer: Effect on Detection of Distant Metastases Comparing 4 Guidelines
Merel T Stegenga, W Edward Visser, Robin P Peeters, Folkert J van Kemenade, Marco Medici, Tessa M van Ginhoven, Frederik A Verburg, Evert F S van Velsen
Journal of the Endocrine Society.2025;[Epub] CrossRef
Ultrasonography of Incidental Thyroid Nodules: A Systematic Review and Meta-analysis of Prevalence
Li-Jen Liao, Shun-Fa Hung, Ping-Chia Cheng, Wan-Lun Hsu
Journal of Medical Ultrasound.2025; 33(4): 365. CrossRef
Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population
Han-Sang Baek, Jeonghoon Ha, Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, Sungju Kim, Dong-Jun Lim, Chul-Min Kim
Endocrinology and Metabolism.2024; 39(2): 310. CrossRef
Thyroid nodules: diagnosis and management
Giorgio Grani, Marialuisa Sponziello, Sebastiano Filetti, Cosimo Durante
Nature Reviews Endocrinology.2024; 20(12): 715. CrossRef
Thyroid cancer-specific mortality during 2005–2018 in Korea, aftermath of the overdiagnosis issue: a nationwide population-based cohort study
Kyeong Jin Kim, Jimi Choi, Sue K. Park, Young Joo Park, Sin Gon Kim
International Journal of Surgery.2024; 110(9): 5489. CrossRef
To Screen or Not to Screen?
Do Joon Park
Endocrinology and Metabolism.2023; 38(1): 69. CrossRef
The 2017 United States Preventive Services Task Force Recommendation for Thyroid Cancer Screening Is No Longer the Gold Standard
Ka Hee Yi
Endocrinology and Metabolism.2023; 38(1): 72. CrossRef
Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms
Jung Hwan Baek
Endocrinology and Metabolism.2023; 38(1): 75. CrossRef
Delayed Surgery for and Outcomes of Papillary Thyroid Cancer: Is the Pendulum Still Swinging?
Giorgio Grani
Clinical Thyroidology.2023; 35(5): 192. CrossRef

Editorial

Diabetes, Obesity and Metabolism
You Can’t Avoid Shift Work? Then Focus on Body Fat Rather than Weight: Eun Kyung Lee; Endocrinol Metab. 2022;37(5):756-758. Published online October 25, 2022; DOI: https://doi.org/10.3803/EnM.2022.501

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Original Articles

Thyroid
Seaweed and Iodine Intakes and SLC5A5 rs77277498 in Relation to Thyroid Cancer: Tung Hoang, Eun Kyung Lee, Jeonghee Lee, Yul Hwangbo, Jeongseon Kim; Endocrinol Metab. 2022;37(3):513-523. Published online May 24, 2022; DOI: https://doi.org/10.3803/EnM.2021.1306

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Background
This study aims to elucidate the associations among dietary seaweed (gim and miyeok/dashima) and iodine intakes, the rs77277498 polymorphism of the SLC5A5 gene codifying the sodium/iodine symporter, and thyroid cancer risk in a Korean population.
Methods
We conducted a case-control study of 117 thyroid cancer cases and 173 controls who participated in the Cancer Screenee Cohort between 2002 and 2014 at the National Cancer Center, Korea. The amount of seaweed and iodine consumption (g/day) was estimated using the residual energy adjustment method. We calculated odds ratios (ORs) and their 95% confidence intervals (CIs) using a multivariable logistic regression model for the separate and combined effect of dietary iodine-based intake and SLC5A5 polymorphism (rs77277498, C>G) on thyroid cancer.
Results
Dietary gim and iodine intakes were inversely associated with thyroid cancer, with ORs of 0.50 (95% CI, 0.30 to 0.83) and 0.57 (95% CI, 0.35 to 0.95), respectively, whereas the associations for dietary miyeok/dashima and total seaweed intakes were not significant. However, compared with individuals carrying the C/C genotype of the rs77277498 polymorphism with a low intake of all dietary factors, those carrying the G allele with a high intake had a lower risk of thyroid cancer, with ORs of 0.25 (95% CI, 0.10 to 0.56), 0.31 (95% CI, 0.12 to 0.77), 0.26 (95% CI, 0.10 to 0.62), and 0.30 (95% CI, 0.12 to 0.73) for the consumption of gim, miyeok/dashima, total seaweed, and iodine, respectively.
Conclusion
In summary, our results supported the evidence of the protective effects of dietary gim and iodine intake against thyroid cancer risk, and this association can be strengthened by SLC5A5 rs77277498 genotypes.

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Vanessa Neto, Catarina Leitão, Marta Estrela, Margarida Fardilha, Maria Teresa Herdeiro, Alexandra Nunes
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Jung-Hwan Cho, Jun Young Kim, Nak Gyeong Ko, Hanaro Park, Byung Soo Kwan, Ji Min Han, Sunghwan Suh, Ji Cheol Bae, Tae Hyuk Kim, Sun Wook Kim, Jae Hoon Chung, Hye Rang Bak, Hye In Kim
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Xueqi Zhang, Fan Zhang, Qiuxian Li, Chuyao Feng, Weiping Teng
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Thyroid
A Multicenter, Randomized, Controlled Trial for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid Lobectomy in Low to Intermediate Risk Thyroid Cancer Patients (MASTER): A Study Protocol: Eun Kyung Lee, Yea Eun Kang, Young Joo Park, Bon Seok Koo, Ki-Wook Chung, Eu Jeong Ku, Ho-Ryun Won, Won Sang Yoo, Eonju Jeon, Se Hyun Paek, Yong Sang Lee, Dong Mee Lim, Yong Joon Suh, Ha Kyoung Park, Hyo-Jeong Kim, Bo Hyun Kim, Mijin Kim, Sun Wook Kim, Ka Hee Yi, Sue K. Park, Eun-Jae Jung, June Young Choi, Ja Seong Bae, Joon Hwa Hong, Kee-Hyun Nam, Young Ki Lee, Hyeong Won Yu, Sujeong Go, Young Mi Kang, MASTER study group; Endocrinol Metab. 2021;36(3):574-581. Published online May 26, 2021; DOI: https://doi.org/10.3803/EnM.2020.943

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Background
Postoperative thyroid stimulating hormone (TSH) suppression therapy is recommended for patients with intermediate- and high-risk differentiated thyroid cancer to prevent the recurrence of thyroid cancer. With the recent increase in small thyroid cancer cases, the extent of resection during surgery has generally decreased. Therefore, questions have been raised about the efficacy and long-term side effects of TSH suppression therapy in patients who have undergone a lobectomy.
Methods
This is a multicenter, prospective, randomized, controlled clinical trial in which 2,986 patients with papillary thyroid cancer are randomized into a high-TSH group (intervention) and a low-TSH group (control) after having undergone a lobectomy. The principle of treatment includes a TSH-lowering regimen aimed at TSH levels between 0.3 and 1.99 μIU/mL in the low-TSH group. The high-TSH group targets TSH levels between 2.0 and 7.99 μIU/mL. The dose of levothyroxine will be adjusted at each visit to maintain the target TSH level. The primary outcome is recurrence-free survival, as assessed by neck ultrasound every 6 to 12 months. Secondary endpoints include disease-free survival, overall survival, success rate in reaching the TSH target range, the proportion of patients with major cardiovascular diseases or bone metabolic disease, the quality of life, and medical costs. The follow-up period is 5 years.
Conclusion
The results of this trial will contribute to establishing the optimal indication for TSH suppression therapy in low-risk papillary thyroid cancer patients by evaluating the benefit and harm of lowering TSH levels in terms of recurrence, metabolic complications, costs, and quality of life.

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Ho-Ryun Won, Eonju Jeon, Da Beom Heo, Jae Won Chang, Minho Shong, Je Ryong Kim, Hyemi Ko, Yea Eun Kang, Hyon-Seung Yi, Ju Hee Lee, Kyong Hye Joung, Ji Min Kim, Younju Lee, Sung-Woo Kim, Young Ju Jeong, Yong Bae Ji, Kyung Tae, Bon Seok Koo
Annals of Surgical Oncology.2023; 30(4): 2254. CrossRef
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Arash Abiri, Khodayar Goshtasbi, Sina J. Torabi, Edward C. Kuan, William B. Armstrong, Tjoson Tjoa, Yarah M. Haidar
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Age-Dependent Clinicopathological Characteristics of Patients with T1b Papillary Thyroid Carcinoma: Implications for the Possibility of Active Surveillance
Ho-Ryun Won, Eonju Jeon, Da Beom Heo, Jae Won Chang, Minho Shong, Je Ryong Kim, Hyemi Ko, Yea Eun Kang, Hyon-Seung Yi, Ju Hee Lee, Kyong Hye Joung, Ji Min Kim, Younju Lee, Sung-Woo Kim, Young Ju Jeong, Yong Bae Ji, Kyung Tae, Bon Seok Koo
Annals of Surgical Oncology.2023; 30(4): 2246. 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
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Mi Rye Bae, Sung Hoon Nam, Jong-Lyel Roh, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim
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Review Article

Thyroid
Best Achievements in Clinical Thyroidology in 2020: Eun Kyung Lee, Young Joo Park; Endocrinol Metab. 2021;36(1):30-35. Published online February 24, 2021; DOI: https://doi.org/10.3803/EnM.2021.103

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This review highlights the most interesting research in thyroidology conducted in 2020. The publications of interest discussed below dealt with the following topics: thyroid dysfunction, risk of thyroid cancer, molecular diagnostics and new therapeutics for thyroid cancer, and thyroid disease in the coronavirus disease 2019 pandemic era.

Citations

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EpCAM activates the ERK-EGR1 signaling axis and promotes TNF-α-induced the progression of anaplastic thyroid cancer
Chi-Chiu Lee, Yi-Jen Su, Sushree Shankar Panda, Chiung-Yi Chiu, Chung-Hsuan Wu, Tsai-Ming Lu, Pi-Chun Li, Yen-Lin Huang, Ruey-Long Hong, Shao-Hsi Hung, Cassian Yee, Stephen Y. Lai, Han-Chung Wu
Journal of Translational Medicine.2025;[Epub] CrossRef
Compensation for iodine deficiency conditions with drugs based on duckweed substrate
M. Kh. Sadulaev, M. I. Usmanova, T. T. Tataev, A. M. Inderbiev, A. S.-A. Zhamalullayla, A. Salamova
BIO Web of Conferences.2023; 76: 03002. CrossRef
Use of long non-coding RNAs for the molecular diagnosis of papillary thyroid cancer
Daham Kim, Juyeon Yu, Jiwon Kim, Yoon-a Hwang, Jin Kyong Kim, Cheol Ryong Ku, Jung Hyun Yoon, Jin Young Kwak, Kee-Hyun Nam, Eun Jig Lee
Frontiers in Oncology.2022;[Epub] CrossRef
Ultrasound-Guided Fine-Needle Aspiration with or without Negative Pressure for Different Types of Thyroid Nodules
Qi Zhou, Wenjun Wu, Fang Wang, Xiaohua Gong, Xiaojun Chen
International Journal of General Medicine.2021; Volume 14: 5475. CrossRef

Original Article

Clinical Study
A Phase II Multi-Center, Non-Randomized, Parallel Group, Non-Inferiority Study to Compare the Efficacy of No Radioactive Iodine Remnant Ablation to Remnant Ablation Treatment in Low- to Intermediate-Risk of Papillary Thyroid Cancer: The MOREthyroid Trial Protocol: Eun Kyung Lee, You Jin Lee, Young Joo Park, Jae Hoon Moon, Ka Hee Yi, Koon Soon Kim, Joo Hee Lee, Sun Wook Cho, Jungnam Joo, Yul Hwangbo, Sujeong Go, Do Joon Park; Endocrinol Metab. 2020;35(3):571-577. Published online September 22, 2020; DOI: https://doi.org/10.3803/EnM.2020.681

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Background
Radioactive iodine (RAI) remnant ablation is recommended in patients with papillary thyroid cancer (PTC) and extrathyroidal extension or central lymph node metastasis. However, there exists little evidence about the necessity of remnant ablation in PTC patients with low- to intermediate-risk, those have been increasing in recent decades.
Methods
This multicenter, prospective, non-randomized, parallel group clinical trial will enroll 310 eligible patients with low- to intermediate-risk of thyroid cancer. Inclusion criteria are patients who recently underwent total thyroidectomy for PTC with 3 or less tumors of size 1≤ to ≤2 cm with no microscopic extension and N0/x, or size ≤2 cm with microscopic extension and/or N1a (number of lymph node ≤3, size of tumor foci ≤0.2 cm, and lymph node ratio <0.4). Patients choose to undergo RAI ablation (¹³¹I, dose 1.1 GBq) or diagnostic whole-body scan (DxWBS) (¹³¹I or ¹²³I, dose 0.074 to 0.222 GBq), followed by subsequent measurement of stimulated thyroglobulin (sTg) within 1 year. Survey for quality of life (QOL) will be performed at baseline and at 1 year after follow-up. The total enrollment period is 5 years, and patients will be followed up for 1 year. The primary endpoint is the non-inferiority of surgery alone to surgery with ablation in terms of biochemical remission (BCR) rate (sTg ≤2 ng/mL) without evidence of structural recurrence. The secondary endpoint was the difference of QOL.
Conclusion
This study will evaluate whether surgery alone achieves similar BCR and improved QOL compared to RAI ablation in patients with low- to intermediate-risk PTC within 1 year.

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Radioactive Iodine Therapy in Differentiated Thyroid Cancer: Summary of the Korean Thyroid Association Guidelines 2024 from Nuclear Medicine Perspective, Part-II
So Won Oh, Sohyun Park, Ari Chong, Keunyoung Kim, Ji-In Bang, Youngduk Seo, Chae Moon Hong, Sang-Woo Lee
Nuclear Medicine and Molecular Imaging.2025; 59(1): 8. CrossRef
Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 6. Radioactive Iodine Treatment after Thyroidectomy 2024
Sohyun Park, Ari Chong, Ho-Cheol Kang, Keunyoung Kim, Sun Wook Kim, Dong Gyu Na, Young Joo Park, Ji-In Bang, Youngduk Seo, Young Shin Song, So Won Oh, Eun Kyung Lee, Dong-Jun Lim, Yun Jae Chung, Chae Moon Hong, Sang-Woo Lee
International Journal of Thyroidology.2024; 17(1): 97. CrossRef

Review Article

Thyroid
Natural Killer Cells and Thyroid Diseases: Eun Kyung Lee, John B. Sunwoo; Endocrinol Metab. 2019;34(2):132-137. Published online June 24, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.132

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Abnormal production of thyroid hormone is one of the common endocrine disorders, and thyroid hormone production declines with age. The aging process also negatively affects the immune system. An interaction between endocrine system and the immune system has been proposed to be bidirectional. Emerging evidence suggests an interaction between a lymphocyte population, called natural killer (NK) cells and thyroid gland function. Here, we review the relationship between NK cells and thyroid function and disease.

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Corrigendum

Miscellaneous
Corrigendum: Author's Name Correction. Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro): Jae Hoon Moon, Ji-hoon Kim, Eun Kyung Lee, Kyu Eun Lee, Sung Hye Kong, Yeo Koon Kim, Woo-Jin Jeong, Chang Yoon Lee, Roh-Eul Yoo, Yul Hwangbo, Young Shin Song, Min Joo Kim, Sun Wook Cho, Su-jin Kim, Eun-Jae Chung, June Young Choi, Chang Hwan Ryu, You Jin Lee, Jeong Hun Hah, Yuh-Seog Jung, Junsun Ryu, Yunji Hwang, Sue K. Park, Ho Kyung Sung, Ka Hee Yi, Do Joon Park, Young Joo Park; Endocrinol Metab. 2018;33(3):427. Published online August 14, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.3.427

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Invasiveness and Metastatic Aggressiveness in Small Differentiated Thyroid Cancers: Demography of Small Papillary Thyroid Carcinomas in the Swedish Population
Haytham Bayadsi, Martin Bergman, Malin Sund, Joakim Hennings
World Journal of Surgery.2020; 44(2): 461. CrossRef
Clinical and pathologic predictors of lymph node metastasis in papillary thyroid microcarcinomas
Ling Zhao, Xiaoya Sun, Yukun Luo, Fulin Wang, Zhaohui Lyu
Annals of Diagnostic Pathology.2020; 49: 151647. CrossRef

Original Article

Thyroid
Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro): Jae Hoon Moon, Ji-hoon Kim, Eun Kyung Lee, Kyu Eun Lee, Sung Hye Kong, Yeo Koon Kim, Woo-jin Jung, Chang Yoon Lee, Roh-Eul Yoo, Yul Hwangbo, Young Shin Song, Min Joo Kim, Sun Wook Cho, Su-jin Kim, Eun Jae Jung, June Young Choi, Chang Hwan Ryu, You Jin Lee, Jeong Hun Hah, Yuh-Seog Jung, Junsun Ryu, Yunji Hwang, Sue K. Park, Ho Kyung Sung, Ka Hee Yi, Do Joon Park, Young Joo Park; Endocrinol Metab. 2018;33(2):278-286. Published online June 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.278

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Background

The ongoing Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) aims to observe the natural course of papillary thyroid microcarcinoma (PTMC), develop a protocol for active surveillance (AS), and compare the long-term prognosis, quality of life, and medical costs between the AS and immediate surgery groups.

Methods

This multicenter prospective cohort study of PTMC started in June 2016. The inclusion criteria were suspicious of malignancy or malignancy based on fine needle aspiration or core needle biopsy, age of ≥18 years, and a maximum diameter of ≤1 cm. If there was no major organ involvement, no lymph node/distant metastasis, and no variants with poor prognosis, the patients were explained of the pros and cons of immediate surgery and AS before selecting AS or immediate surgery. Follow-up visits (physical examination, ultrasonography, thyroid function, and questionnaires) are scheduled every 6 months during the first 2 years, and then every 1 year thereafter. Progression was defined as a maximum diameter increase of ≥3, ≥2 mm in two dimensions, suspected organ involvement, or lymph node/distant metastasis.

Results

Among 439 enrolled patients, 290 patients (66.1%) chose AS and 149 patients (33.9%) chose immediate surgery. The median follow-up was 6.7 months (range, 0.2 to 11.9). The immediate surgery group had a larger maximum tumor diameter, compared to the AS group (7.1±1.9 mm vs. 6.6±2.0 mm, respectively; P=0.014).

Conclusion

The results will be useful for developing an appropriate PTMC treatment policy based on its natural course and risk factors for progression.

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Review Article

Acute Hyperglycemia Associated with Anti-Cancer Medication: Yul Hwangbo, Eun Kyung Lee; Endocrinol Metab. 2017;32(1):23-29. Published online March 20, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.1.23

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Abstract PDF PubReader

Hyperglycemia during chemotherapy occurs in approximately 10% to 30% of patients. Glucocorticoids and L-asparaginase are well known to cause acute hyperglycemia during chemotherapy. Long-term hyperglycemia is also frequently observed, especially in patients with hematologic malignancies treated with L-asparaginase-based regimens and total body irradiation. Glucocorticoid-induced hyperglycemia often develops because of increased insulin resistance, diminished insulin secretion, and exaggerated hepatic glucose output. Screening strategies for this condition include random glucose testing, hemoglobin A1c testing, oral glucose loading, and fasting plasma glucose screens. The management of hyperglycemia starts with insulin or sulfonylurea, depending on the type, dose, and delivery of the glucocorticoid formulation. Mammalian target of rapamycin (mTOR) inhibitors are associated with a high incidence of hyperglycemia, ranging from 13% to 50%. Immunotherapy, such as anti-programmed death 1 (PD-1) antibody treatment, induces hyperglycemia with a prevalence of 0.1%. The proposed mechanism of immunotherapy-induced hyperglycemia is an autoimmune process (insulitis). Withdrawal of the PD-1 inhibitor is the primary treatment for severe hyperglycemia. The efficacy of glucocorticoid therapy is not fully established and the decision to resume PD-1 inhibitor therapy depends on the severity of the hyperglycemia. Diabetic patients should achieve optimized glycemic control before initiating treatment, and glucose levels should be monitored periodically in patients initiating mTOR inhibitor or PD-1 inhibitor therapy. With regard to hyperglycemia caused by anti-cancer therapy, frequent monitoring and proper management are important for promoting the efficacy of anti-cancer therapy and improving patients' quality of life.

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Letter

Thyroid
Letter: Expression of Glucagon-Like Peptide-1 Receptor in Papillary Thyroid Carcinoma and Its Clinicopathologic Significance (Endocrinol Metab 2014;29:536-44, Min Jung Jung et al.): Daeyoon Park, Eun Kyung Lee; Endocrinol Metab. 2015;30(2):231-232. Published online June 30, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.2.231

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Case Report

Diabetes, Obesity and Metabolism
Recurrent Hypoglycemia Triggered by Sorafenib Therapy in a Patient with Hemangiopericytoma: Si Won Lee, Eun Kyung Lee, Tak Yun, Young-Woong Won, Eun Jeong Ko, Mihong Choi, Sang Il Choi, Sun Seob Park, Eun Kyung Hong; Endocrinol Metab. 2014;29(2):202-205. Published online June 26, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.2.202

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Targeted therapy has been proven to be one of the most effective cancer treatments. However, some endocrine disorders can occur during treatment with targeted agents. We report the case of a patient who exhibited a wax and wane pattern of hypoglycemia that was attributed to sorafenib therapy. A 32-year-old woman with metastatic hemangiopericytoma visited the emergency department in a stuporous state. Nonhyperinsulinemic hypoglycemia was diagnosed, was exacerbated shortly after sorafenib therapy, and was improved by the cessation of sorafenib with additional glucocorticoid therapy. Patients with metastatic hemangiopericytoma should be carefully monitored with particular attention to hypoglycemia when sorafenib therapy is initiated.

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Muhammad M. Hammami, Najla Duaiji, Ghazi Mutairi, Sabah Aklabi, Nasser Qattan, Mohei El-Din M. Abouzied, Mohamed W. Sous
BMC Cancer.2015;[Epub] CrossRef

Original Article

Clinical Characteristics of Langerhans Cell Histiocytosis with Hypothalamo-Pituitary Involvement.: Eun Shil Hong, Jung Hun Ohn, Jung Hee Kim, Yul Hwang-Bo, Jin Joo Kim, Jung Hee Kwon, Jung Won Lee, Se Youn Choi, Eun Kyung Lee, Sun Wook Cho, Chan Soo Shin, Kyong Soo Park, Hak Chul Jang, Bo Youn Cho, Hong Kyu Lee, Choong Ho Shin, Sei Won Yang, Seong Yeon Kim; Endocrinol Metab. 2011;26(1):38-43. Published online March 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.1.38

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BACKGROUND
Langerhans cell histiocytosis (LCH) is a rare disease that involves a clonal proliferation of Langerhans cells. LCH has a predilection for hypothalamo-pituitary axis (HPA) dysfunction, and this leads to diabetes insipidus (DI) and/or anterior pituitary dysfunction. Here, we describe the endocrine dysfunction and clinical characteristics of adult patients with LCH and we analyzed the differences between an adult-onset type and a childhood-onset type. METHODS: The data was obtained from a retrospective chart review of the patients with LCH that involved the HPA and who attended Seoul National University Hospital. The patients were classified into the adult-onset type (age at the time of diagnosis > or = 16) and the childhood-onset type (age at the time of diagnosis < or = 15). RESULTS: Ten patients (9 males and 1 female) were diagnosed with LCH involving the HPA. Five patients were classified as an adultonset type and the other five patients were classified as a childhood-onset type. The median follow-up duration was 6 (3-12) years for the adult-onset type and 16 (15-22) years for the childhood-onset type. All the patients presented with DI as the initial manifestation of HPA involvement. Four adult-onset patients and three childhood-onset patients had a multi-system disease. Panhypopituitarism developed in three adult-onset patients and in one childhood-onset patient. The pituitary lesion of the three adult-onset patients had spread to the brain during the follow-up duration. In contrast, the pituitary lesion of the other two adult-onset patients without panhypopituitarism and all the childhood-onset patients had not changed. CONCLUSION: DI was the initial presentation symptom of HPA involvement. Anterior pituitary hormone deficiency followed in some patients. Compared with the childhood-onset patients, the adult-onset patients were more likely to have panhypopituitarism and a poor prognosis.

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Pulmonary Langerhans Cell Histiocytosis in an Adult Male Presenting with Central Diabetes Insipidus and Diabetes Mellitus: A Case Report
Yeun Seoung Choi, Jung Soo Lim, Woocheol Kwon, Soon-Hee Jung, Il Hwan Park, Myoung Kyu Lee, Won Yeon Lee, Suk Joong Yong, Seok Jeong Lee, Ye-Ryung Jung, Jiwon Choi, Ji Sun Choi, Joon Taek Jeong, Jin Sae Yoo, Sang-Ha Kim
Tuberculosis and Respiratory Diseases.2015; 78(4): 463. CrossRef
Adult Multisystem Langerhans Cell Histiocytosis Presenting with Central Diabetes Insipidus Successfully Treated with Chemotherapy
Jung-Eun Choi, Hae Ri Lee, Jung Hun Ohn, Min Kyong Moon, Juri Park, Seong Jin Lee, Moon-Gi Choi, Hyung Joon Yoo, Jung Han Kim, Eun-Gyoung Hong
Endocrinology and Metabolism.2014; 29(3): 394. CrossRef

Review Article

Metabolic Regulation of Nuclear Receptors.: Eun Kyung Lee, Young Joo Park; J Korean Endocr Soc. 2008;23(3):155-164. Published online June 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.3.155

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No abstract available.

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Microwave-Promoted Total Synthesis of Puniceloid D for Modulating the Liver X Receptor
Young Jin Jung, Narges Hosseininasab, Jungjin Park, Soonsil Hyun, Jae-Kyung Jung, Jae-Hwan Kwak
Molecules.2024; 29(2): 416. CrossRef

Case Reports

Mediastinal Uptake Misinterpreted as Metastasis in Papillary Thyroid Cancer.: Eun Kyung Lee, Kyung Won Kim, So Yeon Park, Young Joo Park, Young Tae Kim, June Key Chung, Hwa Young Cho, Yun Hyi Ku, Hee Suk Min, Seong Hoe Park, Do Joon Park, Bo Youn Cho; J Korean Endocr Soc. 2007;22(6):460-464. Published online December 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.6.460

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Radioactive iodine (RAI) therapy is used for the removal of remnant thyroid tissue or metastatic thyroid cancer cells in differentiated thyroid cancer. The main mechanism of the therapy is destruction of cells by radioactive iodine that penetrates the cells though the action of the sodium-iodide symporter (NIS). We experienced a case of a 26-year-old woman with mediastinal uptake as detected on a radioiodine scan, who was previously diagnosed with papillary thyroid cancer. For diagnostic tests including chest computed tomography (CT) and a radioiodine scan, the stimulated thyroglobulin level did not show a definite cause of the mediastinal uptake. During regular follow-up, the thymus became triangular with clear margins. The patient had neither specific symptoms nor physical findings related to the presence of a thymic mass. A subsequent CT scan showed an irregular margin of the thymus, suggestive of thymic metastasis. The patient underwent a mediastinectomy. The removed specimen was composed of normal thymic tissue. Moreover, we demonstrated the presence of human NIS by immunohistochemical analysis. After thymectomy, the mediastinal uptake was markedly decreased as compared to the previous scan. This case suggests that a clinician should be suspicious for the functional uptake of thymus when metastasis is unlikely in a clinical situation.

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Clinical Significance of Diffuse Intrathoracic Uptake on Post-Therapy I-131 Scans in Thyroid Cancer Patients
Hyun Su Choi, Sung Hoon Kim, Sonya Youngju Park, Hye Lim Park, Ye Young Seo, Woo Hee Choi
Nuclear Medicine and Molecular Imaging.2014; 48(1): 63. CrossRef

A Case of Aortic Dissection Associated with Cushing's Syndrome.: Soo Heon Kwak, Eun Jung Lee, Sun Wook Cho, Hyung Jin Choi, Eun Kyung Lee, Young Min Cho, Seong Yeon Kim; J Korean Endocr Soc. 2006;21(6):556-559. Published online December 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.6.556

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Abstract PDF: Herein is reported the case of a 43-year-old woman, who experienced an acute aortic dissection associated with underlying Cushing's syndrome. The patient had central obesity and a moon face of ten years duration, but had never sought medical consultation. On the day of her presentation, she experienced a severe chest pain radiating to her back. Computed tomography revealed a Stanford type B acute aortic dissection and a left adrenal mass. From her hormonal study results, clinical symptoms and signs, she was diagnosed with Cushing's syndrome, which was due to a left adrenal adenoma. After medical treatment to stabilize the aortic dissection, she underwent left adrenalectomy. The aortic lesion of the present patient suggests that hypercortisolemia arising from Cushing's syndrome might be related to the development of acute aortic dissection.

A Case of Adrenocortical Carcinoma showing Variable Cortisol Production during the Clinical Course.: Yun Hyi Ku, Hyung Jin Choi, Jin Taek Kim, Ji Won Yoon, Eun Kyung Lee, Hwa Young Cho, Mi Yeon Kang, Jie Seon Lee, Young Min Cho, Seong Yeon Kim; J Korean Endocr Soc. 2006;21(5):419-423. Published online October 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.5.419

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Abstract PDF: Patients with adrenocortical carcinoma (ACC) present with evidence of excessive adrenal steroid hormone in approximately 60% of cases, in which rapidly progressing Cushing's syndrome with or without virilization is the most frequent presentation. Some patients experience an increase or a decline in cortisol production through the progression of their ACC. We report on an unusual case of a cortisol-producing ACC, and the patient presented with a decline in cortisol production, followed by an increase in cortisol production, through the progression of the tumor. A 65-year-old woman who manifested with facial edema and weight gain was diagnosed with Cushing's syndrome, caused by cortisol producing ACC. The patient was treated with adrenalectomy. However, 8 months later, a metastatic hepatic tumor of recurred ACC was detected. At that time, the hormonal evaluation revealed that the liver mass did not produce any hormones. The patient was treated with metastatectomy. Four months later, a relapsed tumor was detected. Increased cortisol production was observed at that time. We speculate there was a change in the clonal dominance within the ACC and this change might cause such a difference. This is the first case report of ACC that showed variable hormone production during progression.

A Case of Intrathyroidal Parathyroid Adenoma Diagnosed by Fine-Needle Aspiration.: Hye Soo Kim, Eun Kyung Lee, Sung Ha Hwang, Myung Sook Kim, Eun Hee Lee, Jong Min Lee, Suk Young Kim, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2000;15(4-5):614-621. Published online January 1, 2001

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Abstract PDF: Fine-needle aspiration can be successfully utilized in the preoperative localization of abnormal parathyroid tissue. Fine-needle aspirate immunostaining for parathyroid hormone (PTH) or chromogranin and thyroglobulin (Tg) with measurement of PTH and Tg levels in the needle washings (FNAB-PTH and FNAB-Tg) can differentiate an enlarged parathyroid tissue from other cervical masses, such as thyroid nodules and lymph nodes. Parathyroid mass can be successfully aspirated by guidance of ultrasonography or computed tomography. Thyroid nodules are the most frequent cause of reduced accuracy of the imaging studies, such as ultrasonography, computer-assisted tomography and scintigraphy. We report on a case of unsuspected intrathyroidal parathyroid adenoma coexisted with thyroid follicular adenoma presenting two thyroid nodules. After biochemical diagnosis of hyperparathyroidism, we could not localize the parathyroid lesion specifically with any imaging method. Through fine-needle aspiration of two thyroid nodules, we performed the immunostaining for chromogranin and thyroglobulin and the measurement of PTH and thyroglobulin levels in the aspirated materials. The results confirmed the right nodule to be thyroid lesion and the left nodule to be parathyroid lesion preoperatively.

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