Endocrinology and Metabolism

Original Articles

Thyroid
Prognosis of Differentiated Thyroid Carcinoma with Initial Distant Metastasis: A Multicenter Study in Korea: Hosu Kim, Hye In Kim, Sun Wook Kim, Jaehoon Jung, Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Hee Kyung Kim, Ho-Cheol Kang, Ji Min Han, Yoon Young Cho, Tae Hyuk Kim, Jae Hoon Chung; Endocrinol Metab. 2018;33(2):287-295. Published online June 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.287

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Background

Most patients with differentiated thyroid cancer (DTC) have a favorable prognosis. However, patients with DTC and initial distant metastasis have not been commonly found, and their clinical characteristics have seldom been reported. In this study, we analyzed the clinical features and prognosis of patients with DTC and initial distant metastasis in Korea.

Methods

We retrospectively reviewed the clinical data of 242 patients with DTC and initial distant metastasis treated from 1994 to 2013, collected from five tertiary hospitals in Korea.

Results

The patients' median age was 51 years, and 65% were women. They were followed for a median of 7 years. Lung was the most common site of distant metastasis: only lung 149 patients (62%), only bone 49 (20%), other single site one (pleura), and combined sites 43 (40 were lung and bone, two were bone and other site, and one was lung and other site). At the time of diagnosis, 50 patients (21%) had non-radioactive iodine (RAI) avidity. Five-year disease-specific survival (DSS) was 85% and 10-year DSS was 68%, which were better than those in previous studies. After multivariate analysis, old age, male sex, metastatic site, and histologic type (follicular type) were significant factors for poor prognosis. However, negative RAI avidity status was not a significant prognostic factor after adjusting for other variables.

Conclusion

The prognosis of Korean patients with DTC and initial distant metastasis was better than in previous studies. Old age, male sex, metastasis site, and histologic type were significant prognostic factors.

Citations

Citations to this article as recorded by

Case report: A case of hyperthyroidism secondary to bone metastasis of differentiated thyroid cancer
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Thyroid Hormone Withdrawal versus Recombinant Human TSH as Preparation for I-131 Therapy in Patients with Metastatic Thyroid Cancer: A Systematic Review and Meta-Analysis
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Molecular Theranostics in Radioiodine-Refractory Differentiated Thyroid Cancer
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Differentiating pulmonary metastasis from benign lung nodules in thyroid cancer patients using dual-energy CT parameters
Taeho Ha, Wooil Kim, Jaehyung Cha, Young Hen Lee, Hyung Suk Seo, So Young Park, Nan Hee Kim, Sung Ho Hwang, Hwan Seok Yong, Yu-Whan Oh, Eun-Young Kang, Cherry Kim
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Feasibility of Recombinant Human TSH as a Preparation for Radioiodine Therapy in Patients with Distant Metastases from Papillary Thyroid Cancer: Comparison of Long-Term Survival Outcomes with Thyroid Hormone Withdrawal
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Male sex is not an independent risk factor for recurrence of differentiated thyroid cancer: a propensity score-matching study
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The Journal of Clinical Endocrinology & Metabolism.2020; 105(3): e457. CrossRef
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Dayeong Hong, Sangwook Lee, Taehun Kim, Jung Hwan Baek, Won Woong Kim, Ki‐Wook Chung, Namkug Kim, Tae‐Yon Sung
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Estimating the Growth Rate of Lung Metastases in Differentiated Thyroid Carcinoma: Response Evaluation Criteria in Solid Tumors or Doubling Time?
Eyun Song, Jonghwa Ahn, Min Ji Jeon, Sang Min Lee, Jeong Hyun Lee, Tae Yong Kim, Jung Hwan Baek, Won Bae Kim, Young Kee Shong, Won Gu Kim
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Alfredo Campennì, Daniele Barbaro, Marco Guzzo, Francesca Capoccetti, Luca Giovanella
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Unusual metastases from differentiated thyroid cancers: A multicenter study in Korea
Jee Hee Yoon, Min Ji Jeon, Mijin Kim, A. Ram Hong, Hee Kyung Kim, Dong Yeob Shin, Bo Hyun Kim, Won Bae Kim, Young Kee Shong, Ho-Cheol Kang, Domenico Albano
PLOS ONE.2020; 15(8): e0238207. CrossRef
Extended Real-World Observation of Patients Treated with Sorafenib for Radioactive Iodine-Refractory Differentiated Thyroid Carcinoma and Impact of Lenvatinib Salvage Treatment: A Korean Multicenter Study
Hye-Seon Oh, Dong Yeob Shin, Mijin Kim, So Young Park, Tae Hyuk Kim, Bo Hyun Kim, Eui Young Kim, Won Bae Kim, Jae Hoon Chung, Young Kee Shong, Dong Jun Lim, Won Gu Kim
Thyroid.2019; 29(12): 1804. CrossRef
Clinical outcomes and prognostic factors in patients with no less than three distant organ system metastases from differentiated thyroid carcinoma
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Molecular Profile and Clinical Outcomes in Differentiated Thyroid Cancer Patients Presenting with Bone Metastasis
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Improved survival after early detection of asymptomatic distant metastasis in patients with thyroid cancer
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Risk Factors for Distant Metastasis in Follicular Thyroid Carcinoma in Korea
Shin Dol Jo, Joon-Hyop Lee, Suk Ha Kang, Yun Yeong Kim, Yong Soon Chun, Heung Kyu Park, Sang Tae Choi, Jin Mo Kang, Yoo Seung Chung
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Clinical Outcomes of Differentiated Thyroid Cancer Patients with Local Recurrence or Distant Metastasis Detected in Old Age
Ji Min Han, Ji Cheol Bae, Hye In Kim, Sam Kwon, Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Young Kee Shong, Won Bae Kim
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Efficacy and Affecting Factors of 131I Thyroid Remnant Ablation After Surgical Treatment of Differentiated Thyroid Carcinoma
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Clinical Study
Prevalence of Hyponatremia in Hypothyroid Patients during Radioactive ¹³¹I Ablation for Differentiated Thyroid Cancer: Single Institution Experience: Juan Carlo P. Dayrit, Elaine C. Cunanan, Sjoberg A. Kho; Endocrinol Metab. 2016;31(3):410-415. Published online August 17, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.410

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Background

Hyponatremia developing in hypothyroid patients has been encountered in clinical practice; however, its prevalence has not been well established.

Methods

Thirty patients diagnosed with differentiated thyroid cancer, rendered hypothyroid after surgery and levothyroxine withdrawal, and who are for radioactive iodine (RAI) ablation were included. Serum sodium concentrations were measured twice, at the time of admission for RAI ablation, and before discharge after increased oral fluid intake. The outcome measures were to determine the prevalence of hyponatremia among hypothyroid patients prior to RAI ablation and after oral hydration post-RAI, and to correlate the serum sodium levels pre-RAI and post-RAI with thyroid-stimulating hormone (TSH) concentration and age.

Results

Thirty patients were included, with ages from 23 to 65 years old (median, 40). Two patients (6.7%) were hyponatremic prior to RAI ablation, and eight patients (26.7%) had mild hyponatremia (130 to 134 mEq/L) after RAI and hydration. There was no significant correlation between TSH levels and serum sodium levels prior to or after RAI. There was also no significant correlation between pre- and post-RAI sodium concentration and age.

Conclusions

The prevalence of hyponatremia pre-RAI was 6.7%, and 26.7% post-RAI. No significant correlation was noted between TSH concentration and age on pre- or post-RAI sodium concentrations. Routine measurement of serum sodium post-RAI/isolation is still not advised. Measurement of sodium post-RAI may be considered in patients who are elderly, with comorbid conditions or on medications.

Citations

Citations to this article as recorded by

Is there a causal relationship between hypothyroidism and hyponatremia?
Julie Chen
Therapeutic Advances in Endocrinology and Metabolism.2023;[Epub] CrossRef
Endocrinopathy-induced euvolemic hyponatremia
Talia Diker-Cohen, Benaya Rozen-Zvi, Dana Yelin, Amit Akirov, Eyal Robenshtok, Anat Gafter-Gvili, Daniel Shepshelovich
Internal and Emergency Medicine.2018; 13(5): 679. CrossRef

Endocrine Research
Comparison of Thyroglobulin Measurements Using Three Different Immunoassay Kits: A BRAMHS Tg-Plus RIA Kit, a BRAMHS hTg Sensitive Kryptor Kit, and a Beckman Coulter ACCESS Immunoassay Kit: Mijin Kim, Min Ji Jeon, Won Gu Kim, Jong Jin Lee, Jin-Sook Ryu, Eun-Jung Cho, Dae-Hyun Ko, Woochang Lee, Sail Chun, Won-Ki Min, Tae Yong Kim, Young Kee Shong, Won Bae Kim; Endocrinol Metab. 2016;31(3):462-468. Published online August 2, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.462

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Background

Second-generation thyroglobulin immunometric assays (Tg-IMAs) have been developed with improved sensitivity. Our aim was to compare the diagnostic value of Tg-IMA measurements using a Kryptor (BRAHMS AG) kit (Tg-K) and an ACCESS (Beckman Coulter) kit (Tg-A) with that of the first-generation Tg measurement using a Tg-plus (BRAHMS AG) kit (Tg+).

Methods

We enrolled 82 differentiated thyroid cancer patients who underwent total thyroidectomy with radioactive iodine remnant ablation and who underwent diagnostic whole body scan using recombinant human thyroid stimulating hormone (rhTSH). The Tg+, Tg-K, and Tg-A were measured before rhTSH administration during levothyroxine treatment (suppressed Tg) from the same sample. Serum Tg+ was measured after rhTSH stimulation (stimulated Tg).

Results

Suppressed Tg+ was more significantly correlated with suppressed Tg-K (R²=0.919, P<0.001) than with suppressed Tg-A (R²=0.536, P<0.001). The optimal cut-off values of suppressed Tg+, Tg-K, and Tg-A for predicting stimulated Tg+ of 1 ng/mL were 0.3, 0.2, and 0.2 ng/mL, respectively. The sensitivity, specificity, and accuracy of suppressed Tg+ were 67%, 100%, and 90%, respectively; those of suppressed Tg-K were 83%, 90%, and 88%; those of suppressed Tg-A were 96%, 82%, and 87%, respectively. The positive predictive and negative predictive values of Tg+ were 100% and 87%, respectively; those of Tg-K were 79% and 92%; and those of Tg-A were 73% and 98%.

Conclusion

We could not clearly demonstrate which kit had better diagnostic performance after comparison of first-generation Tg measurements with Tg-IMA measurements. Also, there were kit-to-kit variations between Tg-IMA kits. Suppressed Tg measured by Tg-IMA was insufficient to completely substitute for a stimulated Tg measurement.

Citations

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Comparison of the diagnostic performances of US-guided fine needle aspiration cytology and thyroglobulin measurement for lymph node metastases in patients with differentiated thyroid carcinoma: a meta-analysis
Rong-Bin Liu, Da-Lei Zhou, Bo-Heng Xu, Xin-Hua Yang, Qing Liu, Xiao Zhang, Tao Tang, Zu-Lu Ye, Yue Li
European Radiology.2021; 31(5): 2903. CrossRef
Preoperative Serum Thyroglobulin and Its Correlation with the Burden and Extent of Differentiated Thyroid Cancer
Hosu Kim, So Young Park, Jun-Ho Choe, Jee Soo Kim, Soo Yeon Hahn, Sun Wook Kim, Jae Hoon Chung, Jaehoon Jung, Tae Hyuk Kim
Cancers.2020; 12(3): 625. CrossRef
Estimating the Growth Rate of Lung Metastases in Differentiated Thyroid Carcinoma: Response Evaluation Criteria in Solid Tumors or Doubling Time?
Eyun Song, Jonghwa Ahn, Min Ji Jeon, Sang Min Lee, Jeong Hyun Lee, Tae Yong Kim, Jung Hwan Baek, Won Bae Kim, Young Kee Shong, Won Gu Kim
Thyroid.2020; 30(3): 418. CrossRef
Impact of delayed radioiodine therapy in intermediate‐/high‐risk papillary thyroid carcinoma
Mijin Kim, Minkyu Han, Min Ji Jeon, Won Gu Kim, In Joo Kim, Jin‐Sook Ryu, Won Bae Kim, Young Kee Shong, Tae Yong Kim, Bo Hyun Kim
Clinical Endocrinology.2019; 91(3): 449. CrossRef
Tertiary Care Experience of Sorafenib in the Treatment of Progressive Radioiodine-Refractory Differentiated Thyroid Carcinoma: A Korean Multicenter Study
Mijin Kim, Tae Hyuk Kim, Dong Yeob Shin, Dong Jun Lim, Eui Young Kim, Won Bae Kim, Jae Hoon Chung, Young Kee Shong, Bo Hyun Kim, Won Gu Kim
Thyroid.2018; 28(3): 340. CrossRef
A Follow-Up Strategy for Patients with an Excellent Response to Initial Therapy for Differentiated Thyroid Carcinoma: Less Is Better
Min Ji Jeon, Mijin Kim, Suyeon Park, Hye-Seon Oh, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Won Gu Kim
Thyroid.2018; 28(2): 187. CrossRef
Preoperative serum thyroglobulin predicts initial distant metastasis in patients with differentiated thyroid cancer
Hosu Kim, Young Nam Kim, Hye In Kim, So Young Park, Jun-Ho Choe, Jung-Han Kim, Jee Soo Kim, Jae Hoon Chung, Tae Hyuk Kim, Sun Wook Kim
Scientific Reports.2017;[Epub] CrossRef

Thyroid
Anaplastic Thyroid Cancer: Experience of the Philippine General Hospital: Tom Edward Lo, Cecilia Alegado Jimeno, Elizabeth Paz-Pacheco; Endocrinol Metab. 2015;30(2):195-200. Published online June 30, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.2.195

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Background

Anaplastic thyroid cancer (ATC) is a rare type of thyroid malignancy and one of the most aggressive solid tumors, responsible for between 14% and 50% of the total annual mortality associated with thyroid cancer.

Methods

A retrospective study was made of all ATC cases diagnosed by biopsy in the Philippine General Hospital between 2008 and 2013.

Results

A total of 15 patients were identified, with a median age at diagnosis of 63 years. All tumors were at least 6 cm in size upon diagnosis. All patients had a previous history of thyroid pathology, presenting with an average duration of 11 years. Eleven patients presented with cervical lymphadenopathies, whereas seven exhibited signs of distant metastases, for which the lungs appeared to be the most common site. More than 70% of the patients presented with a rapidly growing neck mass, leading to airway obstruction. Only three patients were treated using curative surgery; the majority received palliative and supportive forms of treatment. In addition, only three patients were offered radiotherapy. Chemotherapy was not offered to any patient. Only two patients were confirmed to still be alive during the study period. The median survival time for the other patients was 3 months; in the majority of cases the patient died within the first year following diagnosis.

Conclusion

Our experience with ATC demonstrated concordance with other institutions with respect to current clinical profile, presentation, and prognosis. An absence of distant metastases and lymph node involvement was associated with improved survival outcomes, whereas age at diagnosis and tumor size did not affect survival. Curative surgery offers the most effective means of prolonging survival. Radiotherapy and chemotherapy in combination with surgery represents a promising treatment strategy.

Citations

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Prior Thyroid and Nonthyroid Cancer History Do Not Significantly Alter Overall Survival in Patients Diagnosed with Anaplastic Thyroid Cancer
Yu Han Chen, Maria Cabanillas, Jared Sperling, Li Xu, Maitrayee Goswami, Anastasios Maniakas, Michelle D. Williams, Stephen Y. Lai, Naifa Busaidy, Ramona Dadu, Mark E. Zafereo, Jennifer Rui Wang
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Marc Gregory Yu, Jonathan Rivera, Cecilia Jimeno
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Review Article

Thyroid
Radioiodine Therapy in Differentiated Thyroid Cancer: The First Targeted Therapy in Oncology: June-Key Chung, Gi Jeong Cheon; Endocrinol Metab. 2014;29(3):233-239. Published online September 25, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.3.233

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Iodide uptake across the membranes of thyroid follicular cells and cancer cells occurs through an active transport process mediated by the sodium-iodide symporter (NIS). The rat and human NIS-coding genes were cloned and identified in 1996. Evaluation of NIS gene and protein expression is critical for the management of thyroid cancer, and several approaches to increase NIS levels have been tried. Identification of the NIS gene has provided a means of expanding its role in radionuclide therapy and molecular target-specific theragnosis (therapy and diagnosis using the same molecular target). In this article, we describe the relationship between NIS expression and the thyroid carcinoma treatment using I-131 and alternative therapeutic approaches.

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Case Report

Hyperprolactinemia-Associated Breast Uptake of Radioiodine Following 131I Postablation Scan in Differentiated Thyroid Cancer.: Jae Hee Ahn, Sun Young Kim, Ye Ji Kim, Suk Young Lee, Jae Hyoung Lee, Seung Hun Kang, Ho Cheol Hong, Sae Jeong Yang, Hye Jin Yoo, Ji A Seo, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Hae Yoon Choi; Endocrinol Metab. 2011;26(4):345-347. Published online December 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.4.345

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Abstract PDF

Scanning with whole-body 131I scintigraphy after surgery has been a valuable diagnostic modality in the surveillance of patients with differentiated thyroid cancer. Radioiodine uptake is rarely observed in non-lactating breast tissue, which mimics thyroid cancer metastasis. We now report a case of a 45-year-old female thyroid cancer patient who underwent radioiodine therapy, and in whom breast uptake of radioiodine was observed on a post-therapy whole body scan. Her serum prolactin level was elevated to 328 ng/mL at the time of the radioiodine uptake, and the hyperprolactinemia was induced by her antipsychotic medications. Six months after she discontinued that medication, her serum prolactin level was normalized to 12.6 ng/mL and breast uptake of iodine was no longer present in a follow-up whole body scan.

Citations

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Incidental Findings of Intense Radioiodine Uptake in Struma Ovarii and Bilateral Nonlactating Breasts Simultaneously on Postablation 131I SPECT/CT for Papillary Thyroid Cancer
Hye-kyung Shim, Mi Ra Kim
Nuclear Medicine and Molecular Imaging.2016; 50(4): 353. CrossRef

Original Article

Diagnostic Significance of Serum Thyroglobulin Measurement in the Follow - up of Patients with differentiated Thyroid Cancer.: Seon Hwa Lee, Byung Sool Moon, Sun Wook Kim, Jae Joon Koh, Do Joon Park, Won Bae Kim, Bo Youn Cho, Hong Kyu Lee; J Korean Endocr Soc. 1999;14(4):667-678. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Although serum thyroglobulin (Tg) has been proved to be a good tumor marker in the follow-up of the well differentiated thyroid cancer, some patients show low detectable Tg with negative 131I scan. In the present study, we tried to determine the lowest level of serum Tg which suggests requirement of aggressive work-up for the recurrent or metastatic thyroid cancer. METHODS: Serum Tg levels were measured in 102 patients with well differentiated thyroid cancer who had underwent thyroidectomy followed by 131I ablative therapy. Of 102 patients, 44 patients had no remnant thyroid tissue, while 58 patients had remnant thyroid. Serum Tg levels were measured while TSH-suppressive dose of T4 was administered (on T4 therapy) and then T4 was discontinued for 4 weeks to increase serum TSH level (off T4 therapy), then serum Tg levels were analyzed in relation to the presence or absence of recurrent or metastatic thyroid cancer, assessed by I scan and operation with reference to the physical examination, chest X-ray and thyroid ultrasonogram. RESULTS: Of 102 patients, 16 patients were found to have recurrent or matastatic thyroid cancer. Among them, 10 patients didnt have any remnant thyroid, while 6 patients had remnant thyroid. Serum Tg was undetectable on T4 therapy in 6 patients, but rose higher than 30 ng/mL off T4 therapy in 2 patients, while Tg remained undetectable in other 4 patients. In all 10 patients whoseTg levels were higher than 1 ng/mL. on T4 therapy, Tg rose higher than 30 ng/mL off T4 therapy. The best cut-off value of serum Tg which suggests recurrent or metastatic disease in patients without remnant thyroid was 3 ng/mL on T therapy (sensitivity 60%, specificity 91%, accuracy 84%) and 30 ng/mL off T4 therapy (sensitivity 80%, specificity 75%, accuracy 77%). In patients with remnant thyroid, cut-off value of serum Tg could not be determined because of the low sensitivity and specificity. CONCLUSION: In patients with well differentiated thyroid cancer who have no remnant thyroid, serum Tg level lower than 3 ng/mL on T4 therapy can warrant following-up of patients only with such clinical measures only such as physical examination and thyroid ultrasonogram. However, patients with Tg level of 3 ng/mL or more requires Tg measurements off T4 therapy and 131I scan to evaluate the possibility of recurrent or metastatic thyroid cancer.

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