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Thyroid
Comprehensive Proteomics and Machine Learning Analysis to Distinguish Follicular Adenoma and Follicular Thyroid Carcinoma from Indeterminate Thyroid Nodules
Hee-Sung Ahn, Eyun Song, Chae A Kim, Min Ji Jeon, Yu-Mi Lee, Tea-Yon Sung, Dong Eun Song, Jiyoung Yu, Ji Min Shin, Yeon-Sook Choi, Kyunggon Kim, Won Gu Kim
Endocrinol Metab. 2025;40(4):623-636.   Published online April 10, 2025
DOI: https://doi.org/10.3803/EnM.2024.2208
  • 4,792 View
  • 147 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
The preoperative diagnosis of follicular thyroid carcinoma (FTC) is challenging because it cannot be readily distinguished from follicular adenoma (FA) or benign follicular nodular disease (FND) using the sonographic and cytological features typically employed in clinical practice.
Methods
We employed comprehensive proteomics and machine learning (ML) models to identify novel diagnostic biomarkers capable of classifying three subtypes: FTC, FA, and FND. Bottom-up proteomics techniques were applied to quantify proteins in formalin-fixed, paraffin-embedded (FFPE) thyroid tissues. In total, 202 FFPE tissue samples, comprising 62 FNDs, 72 FAs, and 68 FTCs, were analyzed.
Results
Close spectrum-spectrum matching quantified 6,332 proteins, with approximately 9% (780 proteins) differentially expressed among the groups. When applying an ML model to the proteomics data from samples with preoperative indeterminate cytopathology (n=183), we identified distinct protein panels: five proteins (CNDP2, DNAAF5, DYNC1H1, FARSB, and PDCD4) for the FND prediction model, six proteins (DNAAF5, FAM149B1, RPS9, TAGLN2, UPF1, and UQCRC1) for the FA model, and seven proteins (ACTN4, DSTN, MACROH2A1, NUCB1, SPTAN1, TAGLN, and XRCC5) for the FTC model. The classifiers’ performance, evaluated by the median area under the curve values of the random forest models, was 0.832 (95% confidence interval [CI], 0.824 to 0.839) for FND, 0.826 (95% CI, 0.817 to 0.835) for FA, and 0.870 (95% CI, 0.863 to 0.877) for FTC.
Conclusion
Quantitative proteome analysis combined with an ML model yielded an optimized multi‐protein panel that can distinguish FTC from benign subtypes. Our findings indicate that a proteomic approach holds promise for the differential diagnosis of FTC.
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Thyroid
Distinct Impacts of Clinicopathological and Mutational Profiles on Long-Term Survival and Recurrence in Medullary Thyroid Carcinoma
Moon Young Oh, Kyong Yeun Jung, Hoonsung Choi, Young Jun Chai, Sun Wook Cho, Su-jin Kim, Kyu Eun Lee, Eun-Jae Chung, Do Joon Park, Young Joo Park, Han-Kwang Yang
Endocrinol Metab. 2024;39(6):877-890.   Published online November 5, 2024
DOI: https://doi.org/10.3803/EnM.2024.2027
  • 5,957 View
  • 131 Download
  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Medullary thyroid carcinoma (MTC) has a poorer prognosis than differentiated thyroid cancers; however, comprehensive data on the long-term outcomes of MTC remain scarce. This study investigated the extended clinical outcomes of MTC and aimed to identify prognostic factors.
Methods
Patients diagnosed with MTC between 1980 and 2020 were retrospectively reviewed. Their clinical characteristics, longterm clinical outcomes, and prognostic factors for recurrence and mortality were analyzed.
Results
The study included 226 patients (144 women, 82 men). The disease-specific survival (DSS) rates for all MTC patients at 5-, 10-, 20-, and 30-year intervals were 92.7%, 89.4%, 74.3%, and 68.1%, respectively. The recurrence-free survival (RFS) rates were 71.1%, 56.1%, 40.2%, and 32.1% at these intervals. DSS was comparable between the groups from 1980–2009 and 2010–2020 (P=0.995); however, the 1980–2009 group had significantly lower RFS rates (P=0.031). The 2010–2020 group exhibited greater extents of surgical and lymph node dissection (P=0.003) and smaller tumors (P=0.003). Multivariate analysis identified extrathyroidal extension as the strongest prognostic factor for both RFS and DSS. Age >55 years and tumor size of ≥2 cm were also significant prognostic factors for DSS, while hereditary disease and lymph node metastasis were significant for RFS. Survival analysis after propensity-score matching of rearranged during transfection (RET)-negative and non-screened RET-positive groups showed comparable DSS but longer RFS in the RET-negative group.
Conclusion
Extrathyroidal extension was identified as the strongest prognostic factor for RFS and DSS. Older age and larger tumor size were associated with decreased DSS, while RET mutation and lymph node metastasis significantly impacted RFS.

Citations

Citations to this article as recorded by  
  • Clinical characteristics and risk analysis of lymph node metastasis in patients with cN0 differentiated thyroid carcinoma
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    Scientific Reports.2026;[Epub]     CrossRef
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  • The impact of microscopic extrathyroidal extension on the prognosis of medullary thyroid carcinoma: A multicenter cohort study
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    Beyza Olcay Ozturk, Umran Keskin, Serhat Uysal, Aysa Hacioglu, Seda Karsli, Burak Andac, Umit Nur Ozbay, Hulyanur Sodan, Sebnem Burhan, Coskun Ates, Ugur Avci, Faruk Kilinc, Selvinaz Erol, Merve Catak, Zafer Pekkolay, Gulhan Akbaba, Goknur Yorulmaz, Sakin
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  • MEDULLARY THYROID CARCINOMA (MTC): A CURRENT REVIEW OF EPIDEMIOLOGY, DIAGNOSIS, AND THERAPY
    Szymon Zysiak, Julia Wawerska, Dawid Głaz, Maksymilian Głaz, Natalia Kamińska, Jędrzej Zaguła, Magdalena Stolarczyk, Aleksandra Jagura-Sukiennik, Mateusz Stronczyński, Kacper Wicha
    International Journal of Innovative Technologies in Social Science.2025;[Epub]     CrossRef
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Review Articles
Thyroid
Tumor Cells and Cancer-Associated Fibroblasts: A Synergistic Crosstalk to Promote Thyroid Cancer
Laura Fozzatti, Sheue-yann Cheng
Endocrinol Metab. 2020;35(4):673-680.   Published online November 9, 2020
DOI: https://doi.org/10.3803/EnM.2020.401
  • 16,482 View
  • 290 Download
  • 34 Web of Science
  • 30 Crossref
AbstractAbstract PDFPubReader   ePub   
Thyroid cancer is the most common endocrine malignancy. Although most thyroid cancer patients are successfully treated and have an excellent prognosis, a percentage of these patients will develop aggressive disease and, eventually, progress to anaplastic thyroid cancer. Since most patients with this type of aggressive thyroid carcinoma will die from the disease, new treatment strategies are urgently needed. Tumor cells live in a complex and dynamic tumor microenvironment composed of different types of stromal cells. Cancer-associated fibroblasts (CAFs) are one of the most important cell components in the tumor microenvironment of most solid tumors, including thyroid cancer. CAFs originate mainly from mesenchymal cells and resident fibroblasts that are activated and reprogrammed in response to paracrine factors and cytokines produced and released by tumor cells. Upon reprogramming, which is distinguished by the expression of different marker proteins, CAFs synthesize and secret soluble factors. The secretome of CAFs directly impacts different functions of tumor cells. This bi-directional interplay between CAFs and tumor cells within the tumor microenvironment ends up fostering tumor cancer progression. CAFs are therefore key regulators of tumor progression and represent an under-explored therapeutic target in thyroid cancer.

Citations

Citations to this article as recorded by  
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    Tong Chen, Xudong Li, Dongken Hong, Lichen Yin, Chen Fang, Xinjian Chen, Zhixue Yang, Peifeng Zhao, Liang Hu, Zhanqing Wang, Lei Cao, Qi Ma
    Thyroid®.2025; 35(10): 1173.     CrossRef
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  • Head-to-Head Comparison of [ 68 Ga]Ga-DOTA.SA.FAPi and [ 68 Ga]Ga-DOTANOC Positron Emission Tomography/Computed Tomography Imaging for the Follow-Up Surveillance of Patients with Medullary Thyro
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Thyroid
Recent Improvements in Genomic and Transcriptomic Understanding of Anaplastic and Poorly Differentiated Thyroid Cancers
Seong-Keun Yoo, Young Shin Song, Young Joo Park, Jeong-Sun Seo
Endocrinol Metab. 2020;35(1):44-54.   Published online March 19, 2020
DOI: https://doi.org/10.3803/EnM.2020.35.1.44
  • 12,871 View
  • 300 Download
  • 21 Web of Science
  • 20 Crossref
AbstractAbstract PDFPubReader   ePub   

Anaplastic thyroid cancer (ATC) is a lethal human cancer with a 5-year survival rate of less than 10%. Recently, its genomic and transcriptomic characteristics have been extensively elucidated over 5 years owing to advance in high throughput sequencing. These efforts have extended molecular understandings into the progression mechanisms and therapeutic vulnerabilities of aggressive thyroid cancers. In this review, we provide an overview of genomic and transcriptomic alterations in ATC and poorly-differentiated thyroid cancer, which are distinguished from differentiated thyroid cancers. Clinically relevant genomic alterations and deregulated signaling pathways will be able to shed light on more effective prevention and stratified therapeutic interventions for affected patients.

Citations

Citations to this article as recorded by  
  • A new broom sweeps clean: CLDN16 surpasses the BRAF-V600E mutation as an unrivaled biomarker in papillary thyroid cancer
    Yefeng Cai, Yawen Guo, Wenli Ma, Pu Cheng, Liehao Jiang, Shuyan Shen, Fahuan Song, Lei Zhu, Yiqun Hu, Yao Chen, Yanting Duan, Xiujun Cai, Quan Li, Guowan Zheng, Minghua Ge
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    Frontiers in Endocrinology.2024;[Epub]     CrossRef
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    Siarhei A. Dabravolski, Nikita G. Nikiforov, Alexander D. Zhuravlev, Nikolay A. Orekhov, Liudmila M. Mikhaleva, Alexander N. Orekhov
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Case Report
A Case of Primary Parathyroid Carcinoma with full-brown Symptom.
Chang Soo Ryu, Deok Ki Kim, Kee Hyun Park, Shi Gyeong Seong, Dong Ho Kim, Sang Min Woo, In Sung Cho
J Korean Endocr Soc. 1996;11(2):221-226.   Published online November 7, 2019
  • 1,955 View
  • 24 Download
AbstractAbstract PDF
Primary hyperparathyroicism is a state of hypersecretion of PTH by the parathyroid. The etiology has not been established. The three possible etiologies of piimary hyperparathyroidism and incidences are adencena(83%), hyperplasia(15%), and carcinoma(1~2%). Parathyroid carcinoma usually presents in the fourth decades. The hallmark preoperative signs are hypercalcemia(serum calcium 15mg/dl). Palpable neck mass and bane and renal disease. Patients may present with multiple signs and syrnptoms, including recurrent nephrolithiasis, peptic ulcers, mental change, less frequently, extensive bone resorption. However, with greater awareness of the disease and wider use of screening tests, including blood calcium determinations, the diagnosis is frequently made in patients who have no symptoms and minimal, if any, signs of the disease ather than hypercalcemia and elevated levels of parathyroid Hormone. An 38-years-old woman was admitted to the hospital due to pain on the left knee joint. We experienced full-brown symptom pertaining to hyperpara- thyroidism. Thus we report a case herein and also discuss clinical anifestation, histologic features and treatment.
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Original Article
Clinical Significance of Routine Measurement of Serum Calcitonin in Korean Patients with Thyroid Nodules as a Screening test of Sporadic Thyroid Medullary Carcinoma.
Young Kee Shong, Cheol Soo Choi, Hye Young Park, Bo Youn Cho
J Korean Endocr Soc. 1996;11(1):11-17.   Published online November 7, 2019
  • 1,707 View
  • 27 Download
AbstractAbstract PDF
Background
: It is not easy to diagnose sporadic medullary thyroid carcinoma(MTC) before surgery and this might lead the patient reoperation and/or lowered chance of definite cure. Methods : The prevalence of sporadic MTC in Korean was studied in patients with thyroid nodules. A prospective study of 1048 consecutive patients with thyroid nodules was performed. In all patients, measurements of basal serum calcitonin, thyroid hormones, TSH, anti-thyroglobulin antibody and anti-thyroperoxidase antibody were undertaken along with technetium-99m thyroid scintigraphy and fine needle aspiration cytology. In patients with elevated basal calcitonin levels, calcium stimulated calcitonin level was determined. Results: Two patient had markedly elevated calcitonin levels(over 3,200 pg/mL and 1,763 pg/ mL) and another one slightly elevated calcitoni#n(71.9 pg/mL). Fine needle aspiration cytology was suggestive of MTC in one and nodular hyperplasia in the other two. They underwent surgery and histological examination revealed MTC in those two with markedly elevated calcitonin levels. The patient with slightly elevated calcitonin, who was on the maintenance hemodialysis due to chronic renal failure, had nodular hyperplasia. Conclusion: MTC was found in 0.19% of patients with thyroid nodules, which was not different with the previously reported prevalence in Europe. Routine measurements of serum calcitonin might be of value to detect sporadic MTC; however, the cost-effectiveness of routine measurement of serum calcitonin is not clear, considering the relatively low prevalence of MTC in Koreans.
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Case Report
A Case of Polyglandular Autoimmune Syndrome.
In Pyo Jun, Suck Hwan Lim, Won Hyep Bae, Seung Jun Kim, Youn Ho Lee, Sun Ho Kim, Jung Kyu Lim, Jin Duk Hur
J Korean Endocr Soc. 1994;10(2):142-147.   Published online November 6, 2019
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AbstractAbstract PDF
Polyglandular autoimmune(PGA) syndrome designates the dysfunction of endocrine and nonendocrine system involving two or more glands on the basis of autoimmunity. There are three types of PGA syndrome and their pathogenesis is still not completely understood. A 27-year-old woman developed polyglandular autoimmune syndrome manifesting insulin-dependent diabetes mellitus, myasthenia gravis and Graves' disease associated papillary thyroid carcinoma. The thyroid antimicrosomal antibody and antiacetylcholine receptor antibody were positive. Her HLA serotype was A2, A11, A62, B60, CW3, CW4, DR4, DR9.We report here a case of polyglandular autoimmune syndrome, type III manifesting insulin-dependent diabetes mellitus, myasthenia gravis and Graves' disease associated with papillary thyroid carcinoma.
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Original Articles
Thyroid
99mTc-Pertechnetate Scintigraphy Predicts Successful Postoperative Ablation in Differentiated Thyroid Carcinoma Patients Treated with Low Radioiodine Activities
Luca Giovanella, Gaetano Paone, Teresa Ruberto, Luca Ceriani, Pierpaolo Trimboli
Endocrinol Metab. 2019;34(1):63-69.   Published online February 15, 2019
DOI: https://doi.org/10.3803/EnM.2019.34.1.63
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AbstractAbstract PDFPubReader   ePub   
Background

Postoperative routine radioiodine (RAI) treatment is currently debated for patients with low-risk differentiated thyroid carcinoma (DTC) patients. If performed, a low 131I activity (i.e., 1 to 2 GBq) is recommended with the aim to ablate thyroid remnant and facilitate subsequent follow-up by thyroglobulin measurement. The purpose of this study was to evaluate the relationship between postsurgical technetium-99m (99mTc)-pertechnetate scintigraphy and the rate of successful remnant ablation after low activity radioiodine ablation in patients with DTC.

Methods

Enrolled were 193 patients with low risk DTC who underwent total thyroidectomy and RAI ablation with a fixed 1.1 GBq activity of 131I. 99mTc-pertechnetate scans were done and thyrotropin stimulated thyroglobulin (sTg) levels measured just before ablation. Ablation effectiveness was assessed 6 to 12 months later by sTg measurement, neck ultrasound and diagnostic whole body scan.

Results

A negative 99mTc-perthecnetate scans was the best predictor of successful ablation (P<0.001) followed by preablative sTg levels <0.8 ng/mL (P=0.008) and 99mTc-pertechnetate uptake rate values <0.9% (P=0.065). Neither sex nor age of the patient at the time of ablation or tumor histology and size showed a significant association with the rate of successful ablation.

Conclusion

The 99mTc-pertechnetate scintigraphy is a simple and feasible tool to predict effectiveness of low activity 131I thyroid to ablate thyroid remnants in patients with DTC.

Citations

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Thyroid
Combined Effects of Baicalein and Docetaxel on Apoptosis in 8505c Anaplastic Thyroid Cancer Cells via Downregulation of the ERK and Akt/mTOR Pathways
Chan Ho Park, Se Eun Han, Il Seong Nam-Goong, Young Il Kim, Eun Sook Kim
Endocrinol Metab. 2018;33(1):121-132.   Published online March 21, 2018
DOI: https://doi.org/10.3803/EnM.2018.33.1.121
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

Anaplastic thyroid cancer (ATC) is one of the most lethal human malignancies. Docetaxel, a microtubule stabilizer, is a common chemotherapeutic agent used to treat various metastatic cancers. However, prolonged use results in various side effects and drug resistance. Flavonoids, such as baicalein, are accepted chemotherapeutic and dietary chemopreventive agents with many advantages, such as greater accessibility, affordability, and lower toxicity, compared with traditional chemotherapy agents. In this study, we evaluated whether baicalein enhances the effects of docetaxel on apoptosis and metastasis in 8505c ATC cells.

Methods

The 8505c cells were treated with baicalein or docetaxel individually and in combination. Cell viability was measured by MTT (thiazolyl blue tetrazolium bromide) assay, and apoptosis was detected by fluorescence microscopy of Hoechst-stained cells. The expression of apoptotic (Bax and caspase-3), anti-apoptotic (Bcl-2), angiogenic (vascular endothelial growth factor [VEGF], transforming growth factor β [TGF-β], E-cadherin, and N-cadherin), and signaling (extracellular signal-regulated kinase [ERK] mitogen activated protein kinase [MAPK], Akt, and mammalian target of rapamycin [mTOR]) proteins was determined by Western blot analysis.

Results

The combination of baicalein (50 or 100 µM) and docetaxel (10 nM) significantly inhibited proliferation and induced apoptosis compared with monotherapies. The combination treatment significantly inhibited the expression of Bax, caspase-3, VEGF, TGF-β1, E-cadherin, N-cadherin, and mTOR, but decreased the expression of Bcl-2 and significantly decreased the phosphorylation of ERK and Akt.

Conclusion

The combination of baicalein and docetaxel effectively induced apoptosis and inhibited metastasis in 8505c cells through downregulation of apoptotic and angiogenic protein expression and blocking of the ERK and Akt/mTOR pathways in 8505c cells. These results suggest that baicalein enhances the anticancer effects of docetaxel in ATC.

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Endocrine Research
Macrophage Densities Correlated with CXC Chemokine Receptor 4 Expression and Related with Poor Survival in Anaplastic Thyroid Cancer
Dae In Kim, Eunyoung Kim, Young A Kim, Sun Wook Cho, Jung Ah Lim, Young Joo Park
Endocrinol Metab. 2016;31(3):469-475.   Published online August 2, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.3.469
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AbstractAbstract PDFPubReader   
Background

Tumor associated macrophages (TAMs) and CXC chemokine receptor 4 (CXCR4) have emerged as potential biomarkers in various human cancers. The aims of this study were to investigate the clinical characteristics of anaplastic thyroid cancer (ATC) patients according to the TAM numbers in the tumor tissue, and to evaluate the associations between CXCR4 expressions and macrophage densities in ATC tumor microenvironment.

Methods

Total 14 ATC samples from thyroid tissue microarray were used. Immunohistochemical staining was performed using anti-CD163 and anti-CXCR4 antibodies. According to the immunoreactivity of CD163, all subjects were divided into two groups: low-CD163 (n=8) and high-CD163 (n=6) groups.

Results

The mean diagnostic age was 65±7 years and the median tumor size was 4.3 cm, ranging 2.5 to 15 cm. Clinicopathological characteristics were not significantly different between low-CD163 and high-CD163 groups, while age of diagnosis was younger in high-CD163 group than that of low-CD163 group with marginal significance (56.9±5.5 years vs. 67.5±6.8 years, P=0.09). However, overall survival was significantly reduced in high-CD163 group (5.5 months [range, 1 to 10]) compared with low-CD163 groups (8.8 months [range, 6 to 121); log-rank test, P=0.0443). Moreover, high-CD163 group showed strong CXCR4 expressions in both cancer and stromal compartments, while low-CD163 group showed relatively weak, stromal-dominant CXCR4 expressions. Additionally, CD163 and CXCR4 expressions showed a strong positive correlation (γ2=0.432, P=0.013).

Conclusion

Increased number of TAMs showed poor overall survival in ATC, suggesting TAMs are potentially a prognostic biomarker for ATC. CXCR4 expression was significantly correlated with CD163-positive TAM densities, which suggest the possible role of CXCR4 in TAM recruitments.

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Close layer
Endocrine Research
Selective Mitochondrial Uptake of MKT-077 Can Suppress Medullary Thyroid Carcinoma Cell Survival In Vitro and In Vivo
Dmytro Starenki, Jong-In Park
Endocrinol Metab. 2015;30(4):593-603.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.593
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AbstractAbstract PDFPubReader   
Background

Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor mainly caused by mutations in the rearranged during transfection (RET) proto-oncogene. Not all patients with progressive MTC respond to current therapy inhibiting RET, demanding additional therapeutic strategies. We recently demonstrated that disrupting mitochondrial metabolism using a mitochondria-targeted agent or by depleting a mitochondrial chaperone effectively suppressed human MTC cells in culture and in mouse xenografts by inducing apoptosis and RET downregulation. These observations led us to hypothesize that mitochondria are potential therapeutic targets for MTC. This study further tests this hypothesis using1-ethyl-2-[[3-ethyl-5-(3-methylbenzothiazolin-2-yliden)]-4-oxothiazolidin-2-ylidenemethyl] pyridinium chloride (MKT-077), a water-soluble rhodocyanine dye analogue, which can selectively accumulate in mitochondria.

Methods

The effects of MKT-077 on cell proliferation, survival, expression of RET and tumor protein 53 (TP53), and mitochondrial activity were determined in the human MTC lines in culture and in mouse xenografts.

Results

MKT-077 induced cell cycle arrest in TT and MZ-CRC-1. Intriguingly, MKT-077 also induced RET downregulation and strong cell death responses in TT cells, but not in MZ-CRC-1 cells. This discrepancy was mainly due to the difference between the capacities of these cell lines to retain MKT-077 in mitochondria. The cytotoxicity of MKT-077 in TT cells was mainly attributed to oxidative stress while being independent of TP53. MKT-077 also effectively suppressed tumor growth of TT xenografts.

Conclusion

MKT-077 can suppress cell survival of certain MTC subtypes by accumulating in mitochondria and interfering with mitochondrial activity although it can also suppress cell proliferation via other mechanisms. These results consistently support the hypothesis that mitochondrial targeting has therapeutic potential for MTC.

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Namgok Lecture 2014
Thyroid
A Closer Look at Papillary Thyroid Carcinoma
Won Bae Kim
Endocrinol Metab. 2015;30(1):1-6.   Published online March 27, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.1.1
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AbstractAbstract PDFPubReader   

Recent surge of thyroid cancer, especially papillary thyroid carcinoma (PTC), ignited a debate on over-diagnosis of cancer. Such increase in incidence is a worldwide phenomenon, but it has been the most prominent in Korea. Although increased detection might have played a major role, some evidences suggest that true increase in incidence have also contributed to such phenomenon. PTC is a very common disease being the most common cancer in human. As the mortality due to PTC is relatively low, understanding pathophysiology of the disease and risk prediction in individual patient have particular importance for optimal management, but little has been known. I suggest a reason for such a commonality of PTC, and would like to describe my view on some aspects of PTC including unresolved issue on management based on our recent observations.

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Case Report
Thyroid
Medullary Thyroid Carcinoma with Ectopic Adrenocorticotropic Hormone Syndrome
Hong Seok Choi, Min Joo Kim, Chae Ho Moon, Jong Ho Yoon, Ha Ra Ku, Geon Wook Kang, Im Il Na, Seung-Sook Lee, Byung-Chul Lee, Young Joo Park, Hong Il Kim, Yun Hyi Ku
Endocrinol Metab. 2014;29(1):96-100.   Published online March 14, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.1.96
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AbstractAbstract PDFPubReader   

Ectopic adrenocorticotropic hormone (ACTH) syndrome is caused most frequently by a bronchial carcinoid tumor or by small cell lung cancer. Medullary thyroid carcinoma (MTC) is a rare etiology of ectopic ACTH syndrome. We describe a case of Cushing syndrome due to ectopic ACTH production from MTC in a 48-year-old male. He was diagnosed with MTC 14 years ago and underwent total thyroidectomy, cervical lymph node dissection and a series of metastasectomies. MTC was confirmed by the pathological examination of the thyroid and metastatic mediastinal lymph node tissues. Two years after his last surgery, he developed Cushingoid features, such as moon face and central obesity, accompanied by uncontrolled hypertension and new-onset diabetes. The laboratory results were compatible with ectopic ACTH syndrome. A bilateral adrenalectomy improved the clinical and laboratory findings that were associated with Cushing syndrome. This is the first confirmed case of ectopic ACTH syndrome caused by MTC in Korea.

Citations

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Close layer
Original Article
Predictive Factors for Incidental Contralateral Carcinoma in Patients with Unilateral Micropapillary Thyroid Carcinoma.
Jung Eun Huh, Sang Soo Kim, Ji Hyun Kang, Bo Gwang Choi, Byung Joo Lee, Jin Choon Lee, Yun Kyung Jeon, Bo Hyun Kim, Soo Geun Wang, Yong Ki Kim, In Joo Kim
Endocrinol Metab. 2012;27(3):194-199.   Published online September 19, 2012
DOI: https://doi.org/10.3803/EnM.2012.27.3.194
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AbstractAbstract PDF
BACKGROUND
Whether thyroid lobectomy alone is a sufficient treatment for papillary thyroid microcarcinoma (PTMC) remains controversial. The aim of this study is to evaluate the predictive factors for incidental contralateral carcinoma in patients confirmed of unilateral PTMC preoperatively. METHODS: Between January 2007 and December 2009, 393 patients underwent thyroid surgery for unifocal and unilateral PTMC preoperatively at Pusan National University Hospital. A total thyroidectomy with central neck dissection was routinely performed for these patients during this study period. RESULTS: Among the 393 cases in the cohort, 77 patients (19.6%) had incidental PTMC in the contralateral lobe. In patients with incidental contralateral carcinoma, there was higher prevalence in extrathyroid extension, occult ipsilateral carcinoma, pathologic Hashimoto's thyroiditis, and central lymph node metastasis compared to those without contralateral carcinoma. The mean tumor size also increased in patients with contralateral carcinoma. Multivariate logistic regression showed that extrathyroid extension (P = 0.049), occult ipsilateral carcinoma (P < 0.001), pathologic Hashimoto's thyroiditis (P = 0.038), and central lymph node metastasis (P = 0.002) were predictive factors for incidental contralateral carcinoma. CONCLUSION: In conclusion, multifocality in the ipsilateral lobe, central lymph node metastasis, extrathyroid extension, and Hashimoto's thyroiditis is associated with the presence of contralateral carcinoma. Thus, if these factors are found by preoperative and/or postoperative evaluation, total thyroidectomy or completion thyroidectomy is necessary for the treatment of PTMC.

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  • Extent of surgery did not affect recurrence during 7‐years follow‐up in papillary thyroid cancer sized 1‐4 cm: Preliminary results
    Min Joo Kim, Myung‐Chul Lee, Guk Haeng Lee, Hoon Sung Choi, Sun Wook Cho, Su‐jin Kim, Kyu Eun Lee, Young Joo Park, Do Joon Park
    Clinical Endocrinology.2017; 87(1): 80.     CrossRef
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Case Reports
Four Cases of Malignant Pleural Effusion in Patients with Papillary Thyroid Carcinoma.
Min Ji Jeon, Ji Hye Yim, Eui Young Kim, Won Gu Kim, Tae Yong Kim, Won Bae Kim, Young Kee Shong
Endocrinol Metab. 2011;26(4):330-334.   Published online December 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.4.330
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AbstractAbstract PDF
Papillary thyroid carcinoma could be a rare cause of malignant pleural effusion. The development of malignant pleural effusion in patients with papillary thyroid cancer is an extremely adverse prognostic indicator. Here, we report four cases that showed development of malignant pleural effusion during the clinical course of the papillary thyroid carcinoma and consider the prognosis. In four patients, the median survival time after the development of malignant pleural effusion was only 17 months.

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  • Pleural fluid due to papillary thyroid cancer
    Tomohiro Tamura, Toshihiro Shiozawa, Hiroaki Satoh, Koichi Kurishima, Katsunori Kagohashi, Norio Takayashiki, Nobuyuki Hizawa
    Oncology Letters.2019;[Epub]     CrossRef
  • Outcome and characteristics of patients with malignant pleural effusion from differentiated thyroid carcinoma
    Chisato Tomoda, Yuna Ogimi, Fumi Saito, Chie Masaki, Junko Akaishi, Kenichi Matsuzu, Akifumi Suzuki, Takashi Uruno, Keiko Ohkuwa, Hiroshi Shibuya, Wataru Kitagawa, Mitsuji Nagahama, Kiminori Sugino, Koichi Ito
    Endocrine Journal.2016; 63(3): 257.     CrossRef
  • A distinctive colour associated with high iodine content in malignant pleural effusion from metastatic papillary thyroid cancer: a case report
    Andrew Rosenstengel, Ee Mun Lim, Michael Millward, YC Gary Lee
    Journal of Medical Case Reports.2013;[Epub]     CrossRef
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A Case of Subacute Thyroiditis Associated with Papillary Thyroid Carcinoma and Takayasu's Arteritis.
Dongwon Yi, Seung Hoon Baek, Seok Man Son, Yang Ho Kang
Endocrinol Metab. 2011;26(4):324-329.   Published online December 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.4.324
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AbstractAbstract PDF
Subacute thyroiditis is a self-limiting inflammation of the thyroid, presenting with painful thyroid swelling, thyrotoxicosis and low radioactive iodine uptake. The characteristic US findings for this disease are focal ill-defined hypoechoic areas in one lobe or diffuse hypoechoic areas in both lobes. Thyroid carcinomas should be included in the differential diagnosis for a lesion with focal hypoechoic areas and have been rarely reported to coexist with subacute thyroiditis. Takayasu's arteritis is an autoimmune disease that affects the aorta and its branches as well as pulmonary arteries. Subacute thyroiditis associated with Takayasu's arteritis is extremely rare, with only three cases being reported. We report here on the first case with the simultaneous diagnosis of subacute thyroiditis, papillary thyroid carcinoma and Takayasu's arteritis.
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Original Article
Association between Serum Thyroid Stimulating Hormone Level and Papillary Thyroid Microcarcinoma in Korean Euthyroid Patients.
Hyun Sook Kim, Seung Joon Lee, Jung Kyu Park, Chang Ho Jo, Ho Sang Shon, Eui Dal Jung
Endocrinol Metab. 2011;26(4):297-302.   Published online December 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.4.297
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AbstractAbstract PDF
BACKGROUND
Thyroid cancer is a common disease and its prevalence is increasing. Recent reports have shown that an elevated thyrotropin (thyroid stimulating hormone, TSH) level is associated with thyroid cancer risk. However, the association between TSH level and thyroid cancer risk is not yet known for euthyroid patients diagnosed with papillary thyroid microcarcinoma (PTMC). METHODS: Our study included 425 patients who underwent thyroid surgery and were diagnosed with PTMC between 2008 and 2009. Control group patients were diagnosed with benign nodules < or = 1 cm in size by US-guided fine needle aspiration. Nodules with one or more suspected malignant-ultrasonographic feature(s) were excluded from this study. Patients who were not euthyroid or who took thyroid medication were also excluded. RESULTS: The mean age of all patients was 48.5 +/- 11.0 years and 88.8% were women. The mean age of those with PTMC was significantly lower than that of the control group. The mean TSH level was 1.78 +/- 0.93 mIU/L, and the mean free T4 level was 15.96 +/- 2.32 pmol/L. There was no difference in TSH level between the PTMC and control groups (1.77 +/- 0.93 mIU/L vs. 1.79 +/- 0.91 mIU/L, P = 0.829). After adjusting for age, TSH level was not correlated with tumor size (r = 0.02, P = 0.678) in the PTMC group. Moreover, the TSH level did not differ between patients with stage I and stage III-IV carcinoma (stage I, 1.77 +/- 0.95 mIU/L; stage III-IV, 1.79 +/- 0.87 mIU/L; P = 0.856). CONCLUSION: TSH levels are not elevated in euthyroid PTMC patients. Thus, further evaluation is needed before serum TSH can be used as a tumor marker for small nodules < or = 1 cm in size in euthyroid patients.

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  • Could Thyroid-Stimulating Hormone Levels Predict Malignancy in Thyroid Nodules with Indeterminate Cytology? Relation between Thyroid-Stimulating Hormone Levels and Malignant Histology in Thyroid Nodules in the Indeterminate 2023 The Bethesda System for Re
    Mariana Mourão, Sofia Guerreiro, Nuno Manso, Isabel Loureiro, Rosário Eusébio, Sule Canberk, Hugo Pinto Marques
    Endocrinology Insights.2025; 20(3): 128.     CrossRef
  • Effectiveness and Safety of Very-Low-Dose Rosuvastatin–Ezetimibe Therapy in Korean Patients with Dyslipidaemia: A Multicentre Prospective Observational Study
    Ji Woong Roh, Moon-hwa Park, Ji-won Son, SungA Bae
    Clinical Drug Investigation.2025; 45(10): 803.     CrossRef
  • Which is the best predictor of thyroid cancer: thyrotropin, thyroglobulin or their ratio?
    Pinar Yazici, Mehmet Mihmanli, Emre Bozkurt, Feyza Yener Ozturk, Mehmet Uludag
    Hormones.2016; 15(2): 256.     CrossRef
  • Evaluation of serum thyroid‐stimulating hormone as indicator for fine‐needle aspiration in patients with thyroid nodules
    Ji Soo Choi, Chung Mo Nam, Eun‐Kyung Kim, Hee Jung Moon, Kyung Hwa Han, Jin Young Kwak
    Head & Neck.2015; 37(4): 498.     CrossRef
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Case Report
Successful Localization of Distant Metastasis in Parathyroid Carcinoma Using Intraoperative Parathyroid Hormone Assay.
Ho Cheol Hong, Sun Won Kim, Tae Hyung Kim, In Hye Cha, Jae Hee Ahn, Hye Jin Yoo, Hee Young Kim, Ji A Seo, Hyun Koo Kim, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Jae Bok Lee, Sei Hyun Baik, Dong Seop Choi
Endocrinol Metab. 2011;26(1):92-96.   Published online March 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.1.92
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AbstractAbstract PDF
Intra-operative parathyroid hormone (IOPTH) assay is a useful tool to confirm complete excision of all hyper-functioning parathyroid gland tissue. In this report, we describe a case with successful localization of distant metastasis in a patient with parathyroid carcinoma using the IOPTH assay. A 53-year-old man presented to our clinic with a serum calcium level of 11.8 mg/dL and an intact PTH level of 233.3 pg/mL. He had been treated for parathyroid carcinoma eleven years ago. Two suspected metastatic lesions were detected on the chest computed tomography. Due to the vastly different surgical field necessary to excise each lesion, we preferentially removed only one lesion and we monitored the other remaining suspected lesion without resection via IOPTH assay. Six months later, the patient's serum calcium and intact PTH levels remained within their normal ranges. To the best of our knowledge, this is the first case to effectively utilize IOPTH assay for the management of metastatic parathyroid carcinoma.

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  • The association of abdominal obesity, obesity and parathyroid hormone in Korean adults (aged≥50 years): The Korea National Health and Nutrition Survey, 2011
    Kyu Su Lee, Yo Sang Yoon, Hyun Yoon
    Journal of the Korea Academia-Industrial cooperation Society.2015; 16(6): 3882.     CrossRef
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Original Article
The Clinical Importance of Minimal Extrathyroid Extension on Tumor Recurrence in Patients with Papillary Thyroid Carcinoma.
Jung Min Kim, Yun Yong Lee, Chang Woon Choi, Sang Moo Lim, Seung Sook Lee, Soo Youn Cho, Guk Haeng Lee, Byeong Cheol Lee, Ka Hee Yi
Endocrinol Metab. 2010;25(4):340-346.   Published online December 1, 2010
DOI: https://doi.org/10.3803/EnM.2010.25.4.340
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AbstractAbstract PDF
BACKGROUND
We wanted to evaluate whether a minimal extrathyroid extension (METE) is associated with the clinicopathological parameters that are indicative of a poor prognosis, including lymph node metastasis, distant metastasis at the time of the initial diagnosis and tumor recurrence, in patients with papillary thyroid carcinoma (PTC), and especially in the patients with papillary thyroid microcarcinoma (PTMC). METHODS: We retrospectively evaluated the medical records of patients with PTC and who had undergone total thyroidectomy with/without subsequent 131I remnant ablation at the Korea Cancer Center Hospital from January 1998 through December 2005. A total of 557 patients with PTC were enrolled in the study. We excluded 13 patients with an unknown status of extension and 29 patients with massive ETE. RESULTS: Of the 515 patients, 401 were found to have a METE. We analyzed the 464 patients who were without distant metastasis at the time of the initial diagnosis and who had a follow-up duration of more than 6 months. METE was not significantly associated with tumor recurrence during the follow-up period (median follow-up period: 122 months, range: 6-142 months): 8% vs. 15% of the patients with and without METE had tumor recurrence, respectively (P = 0.069 by the log-rank test). We analyzed the effect of tumor size in the patients with METE. Size was not significantly associated with tumor recurrence (P = 0.374 by the log-rank test). CONCLUSION: These findings suggest that METE might not be a prognostic factor to predict tumor recurrence in patients with PTC, including PTMC.

Citations

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  • Sonographic Assessment of the Extent of Extrathyroidal Extension in Thyroid Cancer
    Sae Rom Chung, Jung Hwan Baek, Young Jun Choi, Tae-Yon Sung, Dong Eun Song, Tae Yong Kim, Jeong Hyun Lee
    Korean Journal of Radiology.2020; 21(10): 1187.     CrossRef
  • Papillary thyroid microcarcinoma: the significance of high risk features
    Nori L. Bradley, Sam M. Wiseman
    BMC Cancer.2017;[Epub]     CrossRef
  • Clinical and Pathologic Predictors of Lymph Node Metastasis and Recurrence in Papillary Thyroid Microcarcinoma
    Saaduddin Siddiqui, Michael G. White, Tatjana Antic, Raymon H. Grogan, Peter Angelos, Edwin L. Kaplan, Nicole A. Cipriani
    Thyroid®.2016; 26(6): 807.     CrossRef
  • High metabolic tumor volume and total lesion glycolysis are associated with lateral lymph node metastasis in patients with incidentally detected thyroid carcinoma
    Bo Hyun Kim, Seong-Jang Kim, Keunyoung Kim, Heeyoung Kim, So Jung Kim, Won Jin Kim, Yun Kyung Jeon, Sang Soo Kim, Yong Ki Kim, In Joo Kim
    Annals of Nuclear Medicine.2015; 29(8): 721.     CrossRef
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Case Reports
A Case of Coexistence of Parathyroid and Papillary Thyroid Carcinoma.
Yoon Shick Yom, Myung Jun Lee, Hyun Woo Lim, Jeong Ho Park, Sung Tae Kim, Yu Mi Lee, Dong Ju Yang, Youn Zoo Cho, Moon Il Park, Kang Woo Lee, Keun Young Park, Dong Mee Lim, Byung Joon Kim
J Korean Endocr Soc. 2010;25(1):61-67.   Published online March 1, 2010
DOI: https://doi.org/10.3803/jkes.2010.25.1.61
  • 2,791 View
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  • 1 Crossref
AbstractAbstract PDF
Primary hyperparathyroidism is usually caused by a parathyroid adenoma, occasionally by primary parathyroid hyperplasia and rarely by parathyroid carcinoma. Coincidental occurrence of thyroid carcinoma in parathyroid adenoma is not uncommon, but synchronous parathyroid and thyroid carcinoma is extremely rare. Here, we describe a case of synchronous parathyroid carcinoma and papillary thyroid carcinoma.

Citations

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  • A Case of Primary Hyperparathyroidism with Concomitant Papillary Thyroid Carcinoma
    Sang Yoon Kim, Eun Yeong Ha, Sun Young Kwon, Jihyoung Cho, Ho Chan Cho
    Clinical Ultrasound.2025; 10(1): 16.     CrossRef
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A Case of Sporadic Medullary Thyroid Cancer with RET G691S Polymorphism.
Min Kyu Kang, Jung Min Lee, Ji Hyun Kim, Min Young Lee, Ji Hyun Kim, Sung Dae Moon, Je Ho Han, Sang Ah Chang
J Korean Endocr Soc. 2009;24(4):293-297.   Published online December 1, 2009
DOI: https://doi.org/10.3803/jkes.2009.24.4.293
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AbstractAbstract PDF
Sporadic medullary thyroid carcinoma (MTC) is the most common form of MTC and somatic RET proto-oncogene mutations account for approximately 25% of the patients with sporadic MTC. However, other pathogeneses of sporadic MTC are still unclear. Not only RET mutation, but also polymorphisms of RET may have an association with sporadic MTC. We herein describe the association of MTC and RET proto-oncogene polymorphism. A 51-year-old man was diagnosed with MTC, which was incidentally found on a thyroid sonogram. The patient underwent total thyroidectomy and genetic mutational analysis of the RET gene. Genetic testing detected a polymorphism in codon 691 (G691S) on exon 11 of the RET proto-oncogene. His son and daughter had the same polymorphism. We report on this case along with a review of the related literature on RET gene polymorphism of sporadic MTC.
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Original Articles
Clinico-pathologic Characteristics of the Primary Thyroid Cancer in Patients with Breast Cancer.
Hyun Won Shin, Hye Won Jang, Ji Young Park, Jae Hoon Chung, Young Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Sun Wook Kim
J Korean Endocr Soc. 2009;24(4):240-246.   Published online December 1, 2009
DOI: https://doi.org/10.3803/jkes.2009.24.4.240
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AbstractAbstract PDF
BACKGROUND
Both thyroid and breast cancers occur more frequently in women than in men. Some suggest that estrogen plays a role in the tumorigenesis of both cancers. The aim of this study was to identify the prevalence and clinico-pathologic characteristics of primary thyroid cancer in patients with breast cancer. METHODS: We retrospectively obtained clinical and pathologic data for 112 patients diagnosed with both thyroid and breast cancer from a single center. Patients with thyroid cancer were grouped according to the chronological sequence of tumor diagnosis. When thyroid and breast cancers were diagnosed within 12 months of each other, they were considered to have been diagnosed simultaneously. Female patients who had only papillary thyroid cancer were used as a historic control. RESULTS: Between 1994 and 2008, 7,827 patients at our hospital were diagnosed with breast cancer and 6,571 patients with thyroid cancer. There were 112 patients who had both thyroid and breast cancer. All thyroid cancers (111/112) except one hurthle cell cancer were papillary thyroid cancers. Average tumor size of thyroid cancer cases diagnosed 1) after or 2) simultaneously with the diagnosis of breast cancer was significantly lower than that for 3) thyroid cancer cases found before breast cancer diagnosis or 4) historical controls with papillary thyroid cancer [sizes (in cm), respectively, were: 1) 0.9 +/- 0.6 2) 0.9 +/- 0.5 vs 3) 1.4 +/- 0.9 4) 1.4 +/- 1.1, P < 0.05]. No patients had distant metastases and there were no statistically significant differences in known risk factors for recurrence and survival of patients with thyroid cancer. CONCLUSION: Thyroid cancer is the most common second primary malignancy in patients with breast cancer and most of them are papillary thyroid cancers. There are no differences in risk factors for tumor recurrence and patient survival compared with those with conventional papillary thyroid cancer except for differences in tumor size. These difference in size may reflect an increase in medical surveillance in patients after they are diagnosed with breast cancer.

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  • Survival Outcomes in Thyroid Cancer Patients with Co-Occurring Breast Cancer: Evidence of Mortality Risk Attenuation
    Matheus Wohlfahrt Baumgarten, Iuri Martin Goemann, Rafael Selbach Scheffel, Ana Luiza Maia
    Clinical Breast Cancer.2024; 24(6): e519.     CrossRef
  • The prognosis and treatment of primary thyroid cancer occurred in breast cancer patients: comparison with ordinary thyroid cancer
    Chang Min Park, Young Don Lee, Eun Mee Oh, Kwan-Il Kim, Heung Kyu Park, Kwang-Pil Ko, Yoo Seung Chung
    Annals of Surgical Treatment and Research.2014; 86(4): 169.     CrossRef
  • Thyroid Metastasis from Breast Carcinoma Accompanied by Papillary Thyroid Carcinoma
    Song-I Yang, Kwang-Kuk Park, Jeong-Hoon Kim
    Case Reports in Oncology.2014; 7(2): 528.     CrossRef
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Clinical Differences between Classic Papillary Thyroid Carcinoma and Variants.
Ji Young Park, Ji In Lee, Alice Hyun Kyung Tan, Hye Won Jang, Hyun Won Shin, Young Lyun Oh, Jung Hee Shin, Jung Han Kim, Ji Soo Kim, Young Ik Son, Sun Wook Kim, Jae Hoon Chung
J Korean Endocr Soc. 2009;24(3):165-173.   Published online September 1, 2009
DOI: https://doi.org/10.3803/jkes.2009.24.3.165
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AbstractAbstract PDF
BACKGROUND
The outcomes of papillary thyroid carcinoma (PTC) variants have been described in a limited number of studies. The purpose of this study was to compare patient outcomes of PTC variants with those of patients with classic PTC. METHODS: A single-institution retrospective analysis was performed to review 2,366 patients with classic PTC and 159 patients with PTC variants diagnosed between 1994 and 2004. PTC variant patients were divided into two groups, favorable (n = 119, 119 follicular variants including 14 encapsulated follicular variants) and aggressive (n = 40, including 13 diffuse sclerosing, 11 tall cell, six solid, six oncocytic, and four columnar cell variants). RESULTS: Compared with classic PTC, the favorable and aggressive variants had a significantly larger tumor size (P<0.001). The favorable variants had significantly lower rates of bilaterality, multifocality, extrathyroidal invasion, cervical lymph node metastasis, stage III and IV disease, and greater male to female ratio (P<0.05). In particular, the encapsulated follicular variant showed no bilaterality, multifocality, extrathyroidal invasion, lymph node metastasis, and distant metastasis. However, the disease-specific survival and recurrence-free survival of patients with favorable PTC were not different from the patients with classic PTC. The aggressive variants had significantly higher rates of bilaterality and cervical lymph node metastasis compared to the classic PTC (P<0.05). They had significantly reduced disease-specific survival and recurrence-free survival rates (P<0.01). CONCLUSIONS: Knowledge of the nature of PTC variants, especially aggressive types, is important in predicting patient outcome and providing appropriate treatment. Further study is needed to better understand PTC variants.

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  • Ultrasonographic Characteristics of the Follicular Variant Papillary Thyroid Cancer According to the Tumor Size
    Eon Ju Jeon, Young Ju Jeong, Sung Hwan Park, Chang Ho Cho, Ho Sang Shon, Eui Dal Jung
    Journal of Korean Medical Science.2016; 31(3): 397.     CrossRef
  • Follicular Variant of Papillary Thyroid Carcinoma: Distinct Biologic Behavior Based on Ultrasonographic Features
    Sun Jung Rhee, Soo Yeon Hahn, Eun Sook Ko, Jae Wook Ryu, Eun Young Ko, Jung Hee Shin
    Thyroid®.2014; 24(4): 683.     CrossRef
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Search for Materials that Influence Human Medullary Thyroid Carcinoma Cell Proliferation.
Hyun Won Shin, Hye Won Jang, Keun Sook Kim, Ji In Lee, Ji Young Park, Sun Wook Kim, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung
J Korean Endocr Soc. 2009;24(2):93-99.   Published online June 1, 2009
DOI: https://doi.org/10.3803/jkes.2009.24.2.93
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AbstractAbstract PDF
BACKGROUND
Surgical excision is the only effective treatment of medullary thyroid carcinoma (MTC) and there is no certain treatment for recurrence or distant metastasis. Materials that influence MTC cell proliferation were recently reported. Presently, we evaluated the influence of dexamethasone, somatostatin, progesterone, estradiol-17-beta, forskolin and gastrin on MTC cell proliferation and calcitonin secretion. METHODS: Genomic DNA was extracted and sequenced from untreated thyroid TT cells and cells treated with 10-5~10-10 M dexamethasone, somatostatin, progesterone, estradiol-17-beta, forskolin or gastrin, and cultured for 1~6 days. Cell proliferation was assessed using a BrdU assay at days 1, 2, 3, and 6. Calcitonin in the culture medium from dexamethasone-treated TT cells was measured at days 1~3. RESULTS: Replacement of cysteine with tryptophan at codon 634 of exon 11 was evident in treated TT cells. There was no significant difference in cell proliferation at days 1~3 in cells treated with somatostatin, progesterone, estradiol-17-beta, gastrin and forskolin, while proliferation was inhibited in dexamethasone-treated cells in a concentration-dependent manner from 10-5~10-8 M with no inhibition evident at 10-10 M. Calcitonin levels in 10-5~10-8 M dexamethasone-treated cells were decreased. CONCLUSION: Dexamethasone is a potentially useful compound to suppress MTC cell proliferation. Further studies are necessary to explore this potential further prior to clinical use.

Citations

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  • Identification of Growth Regulatory Factors in Medullary Thyroid Carcinoma Cell Line
    Young Suk Jo, Minho Shong
    Journal of Korean Endocrine Society.2009; 24(2): 84.     CrossRef
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Case Report
Two Cases of the Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma.
Hee Kwan Won, Myoung Jun Lee, Joo Ho Park, In Girl Song, Go Eun Lee, Ji Hyun Jeong, Jee Young Cheon, Hae Joung Sul, Dong Mi Lim, Keun Young Park
J Korean Endocr Soc. 2008;23(6):430-437.   Published online December 1, 2008
DOI: https://doi.org/10.3803/jkes.2008.23.6.430
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AbstractAbstract PDF
The diffuse sclerosing variant of papillary thyroid carcinoma (DSPTC) is a rare histological subtype characterized by diffuse involvement of one or both thyroid lobes, widespread lymphatic permeation, prominent fibrosis, squamous metaplasia, abundant psammoma body and lymphatic infiltration. This subtype usually occurs in young female, and exhibits a higher frequency of cervical and distant metastasis. DSPTC clinically resembles Hashimoto's thyroiditis, and often delays the correct diagnosis. We experienced two patients with DSPTC: the one patient presented with a neck mass lasting for a month, and in the other patient, a thyroid lesion was incidentally found during a medical examination.
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Original Articles
Correlation between S100A4 and COX2 Overexpression and Invasiveness of Papillary Thyroid Carcinoma.
Kyungji Lee, Youn Soo Lee, Kyo Young Lee, Woo Chan Park, Young Sil Kim
J Korean Endocr Soc. 2008;23(3):186-192.   Published online June 1, 2008
DOI: https://doi.org/10.3803/jkes.2008.23.3.186
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AbstractAbstract PDF
PURPOSE: Tumor cell invasion is characteristic of malignant neoplasms. S100A4, a member of a family of small calcium binding proteins, and COX2, seem to have a role in promoting progression and invasion of many human cancers. The clinical stage of a papillary thyroid carcinoma (PTC) depends on age, tumor size, and extrathyroidal extension. Extrathyroidal extension is correlated with the invasiveness of a tumor. However, there are no reliable prediction markers for invasiveness. We evaluated S100A4 and COX2 expression in PTCs to determine if expression correlates with invasiveness, and if expression of S100A4 and COX2 are useful as prediction markers. METHODS: The expression of S100A4 and COX2 were evaluated using immunohistochemical analysis in 35 PTC specimens. RESULTS: More intense staining in cells that invaded the front portion rather than the central portion of a PTC was indicative of increased expression of S100A4 and COX2. Therefore, cases were analyzed for extent of staining in tumor cells that invaded the front portion of a PTC. High expression group (higher expression than average expression rate) of S100A4 and COX2 were significantly correlated with extrathyroidal extension (P = 0.0094 and P = 0.0433, respectively). However, no other clinicopathological factors including age, lymph node involvement, and multiplicity were related to expression of S100A4 and COX2, as determined in this study. CONCLUSION: Extrathyroidal extension of a PTC had an unfavorable effect on prognosis. S100A4 and COX2 expression were associated with extrathyroidal extension. These findings suggest that expression of S100A4 and COX2 could be prognostic markers for PTC.
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The Clinical Significance of Retinoic Acid Receptor beta Expressions in Primary and Recurred Metastatic Lymph Node Papillary Thyroid Carcinomas.
Jae Pil Han, Seong Jin Lee, Kyung Chan Choi, Young Euy Park, Hae Ri Lee, Jun Goo Kang, Ohk Hyun Ryu, Chul Sik Kim, Byung Wan Lee, Eun Gyung Hong, Hyeon Kyu Kim, Doo Man Kim, Jae Myung Yoo, Sung Hee Ihm, Hyung Joon Yoo, Moon Gi Choi
J Korean Endocr Soc. 2007;22(6):419-427.   Published online December 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.6.419
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AbstractAbstract PDF
BACKGROUND
The present study was designed to investigate the correlations of retinoic acid receptor beta(RARbeta) expression for primary and recurred metastatic lymph node (LN) papillary thyroid carcinoma (PTC) tissues and the correlations of RARbeta expression with the uptake of I(131) as detected on a whole body scan (WBS). METHODS: Primary and metastatic LN PTC tissues were examined by immunohistochemical methods. Staining positivity was calculated, and staining intensity was graded as negative (0), weak (1+), moderate (2+) and strong (3+). Nuclear staining intensity (NSI) of cells from tissues was also examined. RESULTS: Seventeen patients who had regional cervical LN metastasis without distant metastasis were included in the study, and 13 patients had the abnormal uptake of I(131) as detected on a WBS. In primary PTC tissues, RARbeta staining positivity and intensity of carcinoma cells were significantly higher than those of normal cells but NSI was significantly higher in normal cells than carcinoma cells. Between primary and metastatic LN PTC tissues, RARbeta staining intensity was correlated after controlling for age. Primary PTC tissues from 14 (82.4%) out of 17 patients were concordant between NSI and the uptake of I(131) as detected on a WBS. NSI predicted the I(131) uptake as detected on a WBS with 81.3% positive predicted value (PPV) and 100% negative predicted value. Metastatic LN PTC tissues from 13 (76.5%) out of 17 patients were concordant between NSI and the uptake of I(131) as detected on a WBS. NSI predicted the uptake of I(131) as detected on a WBS with 76.5% PPV. When the results of NSI taken either as positive or negative were correlated with those of the uptake of I(131) as detected on a WBS in primary and metastatic LN PTC tissues, the correlation was not significant after controlling for age. CONCLUSION: Our results demonstrate that nuclear RARbeta expression may be decreased in PTC tissues than normal thyroid tissues, and RARbeta expression in primary PTC tissues as well as in recurred metastatic LN PTC tissues may predict the uptake of I(131) as detected on a WBS.
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Case Report
A Case of Parathyroid Carcinoma Underwent Radiation Therapy on the Metastatic Bone Lesions.
Jun Ho Lee, Young Min Kim, Dae Seong Hwang, Young Tae Hwang, Jun Bum Eum, Jung Min Seo, Dae Hwa Choi, Byeong Seong Kang, Young Ju Noh, Il Seong Nam-Goong, Young Il Kim, Eun Sook Kim
J Korean Endocr Soc. 2007;22(5):344-352.   Published online October 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.5.344
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AbstractAbstract PDF
Parathyroid carcinoma is a rare malignancy that is responsible for only 0.5 to 4% of all cases of primary hyperparathyroidism. Surgery is the only curative treatment. We report a case of a 46-year-old woman referred for a severe osteoporosis with frequent bone fracture associated with hypercalcemia. Initially, though she had multiple osteolytic lesions, we thought that the lesions were brown tumors resulting from hyperparathyroidism. The patient underwent surgery and was diagnosed with parathyroid carcinoma. After surgery, her intact PTH level normalized for brief period of time, but it was again elevated at 6 weeks after surgery. We suggest that the multiple osteolytic lesions were metastases because there was no evidence of local recurrence of parathyroid carcinoma, and the lesions looked like metastases on CT and PET-CT. The patient was treated with radiation therapy on the lumbar vertebra, one a site of the metastatic lesions. After radiotherapy, her serum intact PTH was decreased.

Citations

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  • Successful Localization of Distant Metastasis in Parathyroid Carcinoma Using Intraoperative Parathyroid Hormone Assay
    Ho Cheol Hong, Sun Won Kim, Tae Hyung Kim, In Hye Cha, Jae Hee Ahn, Hye Jin Yoo, Hee Young Kim, Ji A Seo, Hyun Koo Kim, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Jae Bok Lee, Sei Hyun Baik, Dong Seop Choi
    Endocrinology and Metabolism.2011; 26(1): 92.     CrossRef
  • Nonfunctional Parathyroid Carcinoma: A Case Report
    Sang Gyu Choi
    The Journal of the Korean Society for Therapeutic Radiology and Oncology.2010; 28(2): 111.     CrossRef
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Original Articles
ras Mutation in Korean Papillary Thyroid Carcinomas.
Jung Hwa Jung, Keun Sook Kim, Tae Sik Jung, Young Lyun Oh, Hye Won Jang, Hye Seung Jung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung
J Korean Endocr Soc. 2007;22(3):203-209.   Published online June 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.3.203
  • 2,871 View
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AbstractAbstract PDF
BACKGROUND
RET/PTC rearrangement and mutations of BRAF and ras are well-known oncogenes involved in the pathogenesis of papillary thyroid carcinoma (PTC). The prevalence of RET/PTC rearrangement and BRAF mutations were 0~13% and 66~83% in Korean patients with PTC, respectively. We evaluated the prevalence of ras mutations in surgical specimens of PTC, and we compared them with the patients' clinical features. SUBJECTS AND METHODS: We included the surgical specimens of 49 PTCs and a few follicular thyroid carcinomas (FTCs) and follicular adenomas (FAs) as positive controls. Polymerase chain reaction, single strand conformation polymorphism and direct sequence analysis were consecutively performed to detect ras mutations. RESULTS: No mutations of the ras oncogenes were detected in 49 PTCs. However, heterozygous mutations of the ras oncogenes were found in a FTC and FA as positive controls, respectively. CONCLUSION: These findings suggested that ras mutation is not or rarely related to the tumorigenesis of PTCs in Koreans. Therefore, BRAF mutations and RET/PTC rearrangement, rather than ras mutation, might contribute the development of PTC in Koreans.
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p53, p21 and bcl-2 Protein Expressions and the Clinical Significance in Papillary Thyroid Carcinoma.
Tae Sik Jung, Keun Sook Kim, Young Lyun Oh, Jung Hwa Jung, Eun Young Lee, Hye Seung Jung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung
J Korean Endocr Soc. 2007;22(2):98-104.   Published online April 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.2.98
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AbstractAbstract PDF
BACKGROUND
There have been some investigations concerning the role of p53, p21 and bcl-2 protein expressions for the tumorigenesis of thyroid cancer. It had been debated that these protein expressions were associated with aggressive features of papillary thyroid carcinoma. We studied to evaluate the prevalence of these protein expressions and their clinical significances in papillary thyroid carcinoma. METHODS: We selected 49 patients with papillary thyroid carcinoma who had been operated on at Samsung Medical Center during the last 10 years. Immunohistochemical staining for p53, p21 and bcl-2 was done by the use of paraffin embedded tissues. We analyzed the results of immunohistochemical staining for p53, p21 and bcl-2 and the correlation with the patients' age, gender, tumor size, multifocality, tumor invasion to both lobes, extrathyroidal invasion, cervical lymph node invasion, distant metastasis and the clinical outcomes. RESULTS: Immunohistochemical staining for p53 was positive in 10 patients (20%), p21 was positive in 36 patients (73%) and bcl-2 was positive in 18 patients (37%). The p53 and bcl-2 expressions were not associated with the clinical parameters. Tumor multifocality and extrathyroidal invasion were significantly higher in the p21 positive group (both P < 0.05). CONCLUSION: This study showed that the p21 protein expression was associated with tumor multifocality and extrathyroidal invasion in the patients with papillary thyroid carcinoma. Immunohistochemical stains for p21 may be used as a parameter for tumor aggressiveness in papillary thyroid carcinoma.

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  • Clinicopathologic and Diagnostic Significance of p53 Protein Expression in Papillary Thyroid Carcinoma
    Mi Kyung Shin, Jeong Won Kim
    Asian Pacific Journal of Cancer Prevention.2014; 15(5): 2341.     CrossRef
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Case Report
A Case of Thyroid Microcarcinoma with Multiple Metastases, Including Liver Metastasis.
Sang Jin Lee, Won Gu Kim, Hyung Yong Kim, Hyun Gi Lee, Tae Yong Kim, Youn Suck Koh
J Korean Endocr Soc. 2007;22(1):50-54.   Published online February 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.1.50
  • 2,596 View
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AbstractAbstract PDF
A 65-year-old woman presented with a dry cough and multiple various sized nodules in both lungs on chest X-ray. A CT scan showed a 9.5 cm sized hypervascular mass in the liver and a 5.5 cm sized intraabdominal mass. A percutaneous needle biopsy of one of the lung nodules revealed a metastatic follicular thyroid carcinoma. Therefore, thyroid ultrasonography was performed, which revealed a 1 cm sized nodule in the right thyroid lobe. Cytology, obtained by ultrasonography guided fine needle aspiration, revealed a follicular neoplasm. The tumor cells were weakly positive on galectin-3 immunostaining, which favored a follicular carcinoma. An ultrasonography guided biopsy of the liver and EUS (endoscopic ultrasonography)-guided biopsy of the intraabdominal mass revealed a metastatic follicular thyroid carcinoma in the liver and peritoneum. We report a very rare case of a follicular thyroid microcarcinoma, with multiple metastases to the lung, liver and peritoneum.
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Original Articles
The Relationship between the Expression of MHC Class II Antigens and the Clinical Prognosis of Papillary Thyroid Carcinoma Patients.
Jun Chul Lee, Seul Young Kim, Yun Sun Choi, Youn Sun Bai, Yun Jeung Kim, Ihn Suk Lee, Ki Hyun Kwon, So Young Rha, Bon Jeong Ku, Young Kun Kim, Heung Kyu Ro, Shengjin Li, Jin Man Kim, Young Suk Jo, Minho Shong
J Korean Endocr Soc. 2007;22(1):26-34.   Published online February 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.1.26
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AbstractAbstract PDF
BACKGROUND
Papillary thyroid carcinoma is among the most curable cancers, but some patients are at high risk for recurrence or even death. MHC antigens are essential molecules for the pathogenesis of carcinoma and also the physiologic immune responses against tumor. However, there is no data about the relationship between the expression of MHC antigens and the clinical prognosis of papillary thyroid carcinoma patients. METHODS: We analyzed the relationship between the various prognostic factors and the MHC antigen expression by conducting a retrospective study of 215 patients, who had undergone thyroidectomy for papillary thyroid carcinoma between 1987 and 2003. RESULTS: The expressions of MHC class II antigens were more frequent in papillary thyroid carcinoma than in the other thyroid diseases. Yet there was no statistically significant relationship between most of the clinicopathological factors and the expression of MHC class II antigens in papillary thyroid carcinoma patients. Interestingly, an HLA-DR expression was found in 8 (30.8%) of the 26 patients in the recurrence group and in 13 (76.5%) of the 17 patients in the non-recurrence group, and HLA-DP/DQ immunoreactivity was positive in 10 (38.5%) cases of the recurrence group and in 14 (82.4%) cases of the non-recurrence group. CONCLUSION: Papillary thyroid carcinoma showed a more frequent expression of MHC Class II antigens. However, the recurred papillary thyroid carcinoma showed a tendency to downregulate the expression of MHC class II antigens. Hence, the molecular mechanism for the expression of MHC class II antigens might have a role in the recurrence of papillary thyroid carcinoma.
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A Retrospective Review of the Effectiveness of Recombinant Human TSH-Aided Radioiodine Treatment of Differentiated Thyroid Carcinoma.
Min Ah Na, Sun Hae Shin, Yang Ho Kang, Seok Man Son, In Joo Kim, Yong Ki Kim
J Korean Endocr Soc. 2006;21(4):274-280.   Published online August 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.4.274
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AbstractAbstract PDF
BACKGROUND
The aim of the study was to evaluate the biochemical effects of recombinant human thyroid stimulating hormone (rhTSH) as an adjunct to radioiodine (RI) treatment of a differentiated thyroid carcinoma (DTC). We retrospectively reviewed the clinical response rates of DTC patients treated with RI after thyroid hormone withdrawal and compared with those after rhTSH stimulation. METHOD: We included the patients treated with RI for locally recurrent DTC from February 1, 2002 to August 31, 2005 and followed with diagnostic studies at our hospital. Forty totally (or near totally) thyroidectomized adults were included in this study. Nine patients underwent RI treatment after rhTSH stimulation while euthyoid on L-thyroxine (LT4), and 31 patients were treated with RI after thyroid hormone withdrawal. The clinical response was defined as >25% decrease in serum thyroglobulin (Tg) level on LT4 3 months after the RI treatment. RESULTS: In each group, serum Tg levels were significantly decreased 3 months after the RI treatment. And we found that 77.8 and 71.0% of those prepared by rhTSH and LT4 withdrawal, respectively, had clinical responses 3 months after the RI treatment by our criteria and there was no significant difference in response rates between two groups (P=0.238). CONCLUSIONS: Given the biases that exist in retrospective studies, at the current time we cannot recommend the routine use of rhTSH to prepare RI treatment of DTC. However, our study provided preliminary evidence that rhTSH effectively aided RI treatment of DTC at least to an equivalent degree as LT4 withdrawal.
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Analysis of the Pharmacokinetics of Recombinant Human TSH in Patients with Thyroid Papillary Carcinoma.
Tae Sik Jung, Hye Seung Jung, Jung Hwa Jung, Yun Jae Chung, Eun Young Oh, Young Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung
J Korean Endocr Soc. 2006;21(3):204-212.   Published online June 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.3.204
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AbstractAbstract PDF
BACKGROUND
Individual variations of the pharmacokinetics of recombinant human TSH (rhTSH) might influence the efficacy of the radioactive iodine (RAI) uptake. We studied to investigate the individual pharmacokinetics of rhTSH and the effect of the anthropometric parameters on the serum TSH levels in patients with thyroid papillary carcinoma. METHODS: We selected 16 patients with conventional rhTSH administration for the preparation of RAI administration between June 2004 and May 2005. We measured serum TSH levels at 24-hour (prior to second rhTSH injection), 48-hour (peak level, prior to RAI administration) and 96-hour (prior to scanning) after the first rhTSH injection. We analyzed the correlation of each TSH levels with age, height, weight, creatinine clearance, body mass index (BMI), and body surface area (BSA). RESULTS: Peak TSH levels were negatively correlated with weight, BMI, and BSA. Among them, weight was an independent parameter by multivariate analysis. Decrement of serum TSH levels from the peak to the level at 96-hour was negatively correlated with weight, BMI, and BSA. It was positively correlated with increment of serum TSH levels from the level at 24-hour to the peak level. Serum TSH level at 96-hour was lower than 25 mU/L in nine of 16 patients. CONCLUSION: Body weight was inversely correlated with peak TSH level after rhTSH administration. rhTSH-stimulated TSH levels might be exaggerated to unwanted levels, and very rapidly degraded in lower-weighted patients. We should make up for the rhTSH regimen considering the individual variations of its pharmacokinetics.

Citations

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  • Efficacy of Low-dose and High-dose Radioactive Iodine Ablation With rhTSH in Korean Patients With Differentiated Thyroid Carcinoma
    Ji Young Joung, Ji Hun Choi, Yoon Young Cho, Na Kyung Kim, Seo Young Sohn, Sun Wook Kim, Jae Hoon Chung
    American Journal of Clinical Oncology.2016; 39(4): 374.     CrossRef
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Case Reports
A Case of Multiple Endocrine Neoplasia Type 1 with Papillary Thyroid Carcinoma.
Hai Jin Kim, Chul Sik Kim, Hyun Chul Je, Jina Park, Jong Suk Park, Jee Hyun Kong, Eun Seok Kang, Chul Woo Ahn, Bong Soo Cha, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Hang Suk Jang, Soon Won Hong
J Korean Endocr Soc. 2006;21(1):79-84.   Published online February 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.1.79
  • 3,299 View
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AbstractAbstract PDF
This is the first report of papillary thyroid carcinoma combined with multiple endocrine neoplasia type 1 (MEN 1). It is an hereditary syndrome characterized by neoplastic disorders such as pituitary adenoma, parathyroid adenoma or hyperplasia and pancreatic neuroendocrine tumor, such as gastrinoma just like in our case. But sometimes pheochromocytoma, mucosal ganglioneuromas, lipoma, forgut carcinoid and thyroid disease could be accompany the disease, but coincidental papillary thyroid carcinoma was never reported before in Korea. Herein we represent a 39-year-old woman who manifested typical features of MEN 1 with coincidental papillary thyroid carcinoma. Despite with definite family history of MEN 1, her genetic analysis of DNA had not found any germline mutation in MEN 1 gene. Unidentified culprit gene unable further genetic study of finding LOH (loss of heterogeneity) in 11q13, the possible explanation of papillary thyroid carcinoma as a new component of MEN 1. As we have experienced a case of MEN 1 combined with papillary thyroid carcinoma, we report it with the review of literature.

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  • A Case of Multiple Endocrine Neoplasia Type I with Atypical Clinical Course
    Yun Sun Choi, Youn Sun Bai, Bon Jeong Ku, Young Suk Jo, Young Kun Kim, Heung Kyu Ro, Minho Shong
    Journal of Korean Endocrine Society.2008; 23(4): 266.     CrossRef
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A Case of Familial Medullary Thyroid Carcinoma with a E768D Mutation in RET Proto-Oncogene.
Yeon Kyeong Kim, Jin Woo Kim, Sang Mi Ahn, Kyoung Eun Song, Sun Hye Jung, Dae Jung Kim, Yoon Sok Chung, Kwan Woo Lee, Chul Ho Kim, Ji Hee Hong, Seon Yong Jeong, Hyon Ju Kim
J Korean Endocr Soc. 2005;20(4):375-380.   Published online August 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.4.375
  • 3,445 View
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  • 2 Crossref
AbstractAbstract PDF
A medullary thyroid carcinoma, a neoplasm of parafollicular C cell origin, occurs as a sporadic or hereditary disease. A hereditary medullary thyroid carcinoma is an autosomal dominantly inherited disease, which is composed of multiple endocrine neoplasia 2A and 2B, with a familial medullary thyroid carcinoma. Germline mutations of the RET gene are the underlying cause of the majority of hereditary medullary carcinomas. Here, the case of a 42 years-old man with a familial medullary thyroid carcinoma, confirmed by the detection of a RET proto-oncogene mutation at exon 13 on codon 768 from a GAG(Glu) to a GAT(Asp), is described. The patient underwent a total thyroidectomy and modified radical neck dissection. His sister was found to have the same mutant gene.

Citations

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  • A Case of Medullary Thyroid Carcinoma with de novo V804M RET Germline Mutation
    Young Sik Choi, Hye Jung Kwon, Bu Kyung Kim, Su Kyoung Kwon, Yo Han Park, Jeong Hoon Kim, Sang Bong Jung, Chang Hoon Lee, Seong Keun Lee, Shinya Uchino
    Journal of Korean Medical Science.2013; 28(1): 156.     CrossRef
  • A Family of Multiple Endocrine Neoplasia Type 2A with a C634R Mutation and a G691S Polymorphism in RET Proto-oncogene
    Seoung Wook Yun, Won Sang Yoo, Koo Hyun Hong, Bae Hwan Kim, Min Ho Kang, Young Kwang Choo, Hee Yoon Park, Do Hee Kim, Hyun-Kyung Chung, Myung-Chul Chang, Mi Seon Kwon, Hee Jin Kim
    Journal of Korean Endocrine Society.2007; 22(6): 453.     CrossRef
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Original Articles
Chromosomal Analysis of Anaplastic Thyroid Carcinomas by Comparative Genomic Hybridization.
Mi Kyoung Kim, Chang Hun Lee, Jin Mi Song, Kyung Yub Gong, Yong Ki Kim
J Korean Endocr Soc. 2005;20(4):362-374.   Published online August 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.4.362
  • 2,250 View
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AbstractAbstract PDF
BACKGROUND
Compared with common well-differentiated thyroid carcinomas, the genetic alterations underlying the development and progression of anaplastic thyroid carcinomas(ATC) are still uncharacterized. Comparative genomic hybridization(CGH) is a cytogenetic technique that can identify gains and losses in the DNA sequence copy number in tumors. METHODS: The authors studied the changes in the DNA copy number due to CGH in paraffin-embedded tissue blocks of 17 ATC cases, and tried to ascertain whether the genomic changes correlate with the clinicopathological parameters including patients' age, sex, primary tumor size, lymphovascular invasion, extrathyroid extension, regional node metastasis and immunohistochemical expression of cyclin D1. RESULTS: Fourteen of the 17 samples(82.4%) showed chromosomal changes, with a mean number of gains or losses per carcinoma of 3.6(range 2~6; 30 gains and 21 losses). The most frequently detected imbalance was the gain of chromosome 1q, which was seen in 35.7% of cases, particularly commonly in ATC associated with a papillary thyroid carcinoma. Other commonly occurring gains were present in 11q13 and 19(28.6%, respectively). Genomic amplification was detected in all four cases showing the 11q13 gain. Genomic losses were commonly noted in 3q, 6q, 18q andchi(21.4%, respectively). When numerical CGH alterations were compared to the clinicopathological parameters, there were no significant correlations(P>0.05). Cyclin D1 expression was noted in sixteen of the 17 cases(94.1%), but the extent of cyclin D1 expression was not correlated with the numerical CGH alterations(P>0.05). CONCLUSION: Taken together, the aberrations of 1q, 3q, 6q, 11q13 and 18q are relatively common in ATC, and may play an important role it developement. These findings should lead to the characterization of tumor suppressor genes and oncogenes that are potentially involved in the carcinogenesis of ATC. The amplification of 11q13 is characteristically found, but cyclin D1 in this region may be innocent of the aggressiveness of these carcinomas.
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The Effect of Treatment Modalities on Survival Rates of Patients with Anaplastic Thyroid Carcinoma.
Jae Myoung Choi, Mi Jeong Kim, Seung Won Lee, Kyoung Eun Song, Yoon Sok Chung, Kwan Woo Lee, Dae Jung Kim, Sung Hee Choi, So Hun Kim, Min Ho Cho, Yumie Rhee, Chul Woo Ahn, Sung Kil Lim, Kyung Rae Kim
J Korean Endocr Soc. 2005;20(2):127-133.   Published online April 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.2.127
  • 3,278 View
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  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Anaplastic thyroid carcinoma represents 2% to 5% of all thyroid cancers and it is one of the most aggressive human cancers. Local extension at the time of diagnosis and distant metastases are almost always the rule. Its lethality is evidenced by a 5-year survival rate of 3.6% and a median survival time of 4 months. We retrospectively reviewed patients with this disease at 4 tertiary referral centers. METHODS: From 1990 to 2003, 19 cases(9 men and 10 women, mean age: 65.1+/-7.1 years) of anaplastic thyroid carcinoma were reviewed via the medical records. The overall survival rates according to the prognostic factors and the treatment modalities were analyzed. RESULTS: The presenting symptoms included rapidly enlarged neck masses in 16 patients, shortness of breath in 3 patients, hoarseness in 4 patients, dysphagia in 2 patients and chest wall pain in 1 patient. The mean diameter of tumor was 7.2cm. Local extension was seen in all of the cases that had undergone surgery. Distant metastases(lung 6, bone 2, abdominal carcinomatosis 2, brain 1 and mediastinum 1) were seen in 9 patients. Surgical treatment was performed in 10 patients. Radiotherapy was performed in 9 patients and chemotherapy was done in 5 patients; radiotherapy was performed alone in 2 patients, combination chemo-radiotherapy was performed in 3 patients, postoperative radiotherapy was performed in 2 patients and postoperative combination chemo-radiotherapy was performed in 2 patients. 4 patients were treated cons ervatively after the confirmative diagnosis. The overall median survival time was 123 days(range: 23~621 days); the median survival time was 129 days in the treatment group(n=15), and 27 days in the no treatment group (n=4), and significantly higher survival rates were observed for the treated patients(p=0.02). According to the treatment modalities, patients who underwent surgical treatment and postoperative radiotherapy and/or chemotherapy were observed to have significantly higher survival rates than patients in the radiotherapy and/or chemotherapy group(p=0.03), and also than those patients in the surgical treatment only group(p=0.04). CONCLUSION: We found that aggressive surgical treatment and postoperative radiotherapy and/or chemotherapy improved the survival rates of patients with anaplastic thyroid carcinoma even though local invasion and distant metastases was generally observed to occur

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  • Anaplastic Thyroid Carcinoma: Experience of a Single Institute
    Dongbin Ahn, Jin Ho Sohn
    Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2012; 55(1): 37.     CrossRef
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Case Report
A Case of Follicular Thyroid Carcinoma Developed in Pendred Syndrome.
So Hun Kim, Ji Young Jung, Sung Jae Shin, So Young Park, Si Hoon Lee, Yoo Mee Kim, Yu Mie Rhee, Soon Won Hong, Bong Soo Cha, Chul Woo Ahn, Kyung Rae Kim, Sung Kil Lim, Hyun Chul Lee
J Korean Endocr Soc. 2004;19(4):411-418.   Published online August 1, 2004
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AbstractAbstract PDF
Pendred syndrome is an autosomal recessive genetic disorder, which is characterized by sensorineural hearing loss, goiter and a positive perchlorate discharge test. It is caused by mutations of the PDS gene, and its clinical characteristics vary widely. The thyroid function in most cases is normal, or shows only mild hypothyroidism. In Pendred syndrome, there is an organification defect that leads to defective thyroid hormone synthesis, followed by chronic TSH stimulation. Herein is reported a case of a follicular thyroid carcinoma associated with Pendred syndrome. To our knowledge, this is the first case reported in Korea. The patient presented with a huge anterior neck mass, sensorineural hearing loss and a positive perchlorate discharge test. Fine needle aspiration cytology suggested malignancy of the thyroid, and a total thyroidectomy, with central compartment node dissection, was performed. The pathology from the thyroid mass showed a poorly differentiated follicular thyroid carcinoma
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Original Articles
A Case of Multiple Endocrine Neoplasia 2A with Germ Line Mutation of RET Gene.
Hee Young Kim, Ji Yeon Lee, Sung Bum Kim, Kye Won Lee, Ji A Seo, Jeong Heon Oh, Sin Gon Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Nan Hee Kim
J Korean Endocr Soc. 2003;18(5):481-488.   Published online October 1, 2003
  • 1,735 View
  • 19 Download
AbstractAbstract PDF
Multiple endocrine neoplasia 2A (MEN 2A) is an autosomal dominantly inherited disease, composed of medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. The activation of germ-line mutations in the RET proto-oncogene are responsible for MEN 2. The analysis of the RET mutations has replaced the measurement of the calcitonin level in the diagnosis of the MEN carrier state. Specific RET codon mutations correlate with the MEN 2 syndromic variant, the age at onset of the medullary thyroid carcinoma (MTC) and the aggressiveness of the MTC. Herein, our experience of a 47-year-old woman, who had a bilateral pheochromocytoma and MTC, and MEN 2A confirmed by the detection of an RET proto-oncogene mutation at axon 10 on codon 618, is reported. Her sister was found to have the same mutant gene. After a total thyroidectomy and bilateral adrenalectomy, the calcitonin and catecholamine levels were normalized, and the patient discharged without problems. This case is reported, with a review of the literature.
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Analysis of Ret Proto-oncogene Mutation in Korean Patients with Medullary Thyroid Carcinomas.
Hyung Hoon Kim, Hyun Jin Kim, Yun Jae Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Chang Seok Ki, Jong Won Kim, Jae Hoon Chung
J Korean Endocr Soc. 2003;18(4):360-370.   Published online August 1, 2003
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AbstractAbstract PDF
BACKGROUND
Medullary thyroid carcinomas (MTC) have been reported as hereditary in about 25 ~30% of cases. The identification of germline mutation in RET proto-oncogene is important in the diagnosis of hereditary MTC, and occurs in three forms: MEN 2A, MEN 2B and familial MTC (FMTC). To evaluate the prevalence of the relationship of RET proto-oncogene mutation and genotype-phenotype was studied in Korean patients with MTC. METHODS: Genomic DNA was obtained from 29 patients, with MTC, who underwent a total thyroidectomy, between 1997 and 2003, at the Samsung Medical Center. There were 7 male and 22 female patients, with an average age of 39, ranging from 20 to 60 years. Exon 10, 11, 13, 14 and 16 of the RET proto-oncogene were amplified, with specific primers, using PCR. A sequencing analysis was performed on the PCR product using an automatic sequencing analyzer. RESULTS: Nine of the 29 patients (31%) were identified as having RET mutations. The average age of these 9 patients was 33 years, ranging from 20 to 51, with a female to male ratio of 2. Five patients had MEN 2A and one had FMTC, with the other 3 thought to have non-hereditary (sporadic) MTC. The 4 patients with MEN 2A had RET mutations on codon 634 of exon 11 (2 patients, C634R; 2 patients, C634Y) and the other patient on codon 618 of exon 10 (C618R). One patient with FMTC had a mutation on codon 634 (C634W). Three patients with sporadic MTC had RET mutations on codon 634 (2 patients, C634Y; 1 patient, C634S). However, no genotype- phenotype relationship could be found, due to the limited number of patients. CONCLUSION: Thirty-one percent (9/29) of the patients with MTC had RET proto-oncogene mutations. Three-quarters (9/12) of the Korean patients with MEN 2A, including another 7 patients reported in 3 papers in Korea, had RET mutations on codon 634 of exon 11 (4 patients, C634R; 4 patients, C634Y; 1 patient, C634W), but a quarter (3/12) had mutations on codon 618 of exon 10 (2 patients, C618R; 1 patient, C618S). Although no relations could be found between the genotypes and phenotypes, extensive prospective studies will be required to verify this.
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Expression of RET in Thyroid Diseases of a Korean Population.
Si Hoon Lee, Soon Won Hong, Woo Chul Moon, Myoung Ryur Oh, Jin Kyung Lee, Bong Soo Cha, Chul Woo Ahn, Kyung Rae Kim, Sung Kil Lim, Hyun Chul Lee
J Korean Endocr Soc. 2003;18(2):140-152.   Published online April 1, 2003
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AbstractAbstract PDF
BACKGROUND
Activation of the RET proto-oncogene, located on the long arms of chromosome 10, contributes to the development of thyroid cancers in two different ways. Somatic rearrangements of RET with variable genes of activation are frequently found in papillary thyroid carcinomas. And Ggerm-line point mutations are responsible for the development of medullary thyroid carcinoma and the multiple endocrine neoplasia type 2(MEN2). There are several conflicting reports on the influences of RET expression and RET/PTC rearrangements on the clinical outcome of thyroid cancer. Therefore, we performed an examination of RET expression and RET/PTC-1, -2, -3 rearrangements in papillary thyroid carcinomas and other thyroid diseases. METHODS: Twenty-six papillary thyroid carcinomas(PTCs), three follicular thyroid carcinomas (FTCs), one anaplastic thyroid carcinoma(ATC), five follicular adenomas(FAs), nineteen hyperplasias, and two normal thyroid tissues were included in this study. RT-PCR and immunohistochemistry analysis were done to identify RET gene, RET/PTC rearrangements, and ret RET protein expression. RESULTS: By RT-PCR, 89.4% of PTCs, 100% of FTCs, and 62.1% of hyperplasias expressed the RET gene, but no RET was observed in ATCs, FAs, and normal thyroid tissues. RET/PTC-1, -2,-3 rearrangements were not detected in any specimens. Immunohistochemical results revealed that 76.9% of PTCs, 50% of FAs, 52.3% of hyperplasias, and 20.6% of normal thyroid tissues expressed the RET ret protein, but FTCs and ATCs did not. Most PTCs showed strong cytoplasmic positivity in RET ret immunostaining, but the positive non- PTCs expressed weak and membranous staining. Overall, the two methods for detecting RET gene, RT-PCR and immunohistochemistry showed similar results. CONCLUSION: The RET gene was highly expressed in PTCs. In contrast to the previous reports of that theRET gene expression of RET gene is being limited to PTCs, RET was also expressed in hyperplasias, Fas, and normal thyroid tissues. However, the pattern and the degree of expression of the RET ret protein in non- PTCs were are different from those in PTCs.
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Case Reports
A Case of Multiple Endocrine Neoplasia Type 2B associated with a M918T Mutation in RET Proto-Oncogene.
Tae Yong Kim, Jae Kyung Hwang, Min Kyong Moon, Young Joo Park, Do Joon Park, Seong Yeon Kim, Hong Kyu Lee, Yo Kyu Yoon, Bo Youn Cho
J Korean Endocr Soc. 2003;18(1):85-93.   Published online February 1, 2003
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AbstractAbstract PDF
A multiple endocrine neoplasia type 2B(MEN2B) is the most distinct and aggressive form of the MEN type 2 variants. We report a case of a 24-years-old woman with MEN2B. The patient had previously undergone a Duhamel's operation due to a megacolon at 6 years old, minor surgery to remove small tumors on the lip at 8 years old, and a bilateral osteotomy of the femur, due to coxa valga, at 15 years old. She underwent a total thyroidectomy and neck dissection, due to a growing thyroid nodule, despite thyroxine treatment, at 19 years old. The pathology revealed a medullary thyroid carcinoma. There was no history of MEN 2B in her family. She had prominent lips, multiple oral mucosal masses, and marfanoid habitus. During the subsequent follow-up, a positron emission tomogram was taken due to a persistently high level of serum calcitonin, despite repeated neck dissections, which revealed a mass in the right adrenal gland. Adrenomedullary function tests showed high levels of urinary catecholamine metabolites, and a genetic analysis of the peripheral leukocyte showed a codon 918 mutation (Met918Thr) at exon 16 of the RET proto-oncogene. The patient underwent a right adrenalectomy and the pathology revealed a pheoch-romocytoma.
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A Case of Papillary Thyroid Carcinoma Combined with Multiple Endocrine Neoplasia Type 2A.
Ja kyung Kim, Hae Won Chung, Hye Sun Seo, Dae Jung Kim, Sang Su Chung, Young Duk Song, Kuk Hwan Kwon, Yoon Mi Jin, Mi Kyung Lee, Sung Kil Lim, Il Jin Kim, Hio Chung Kang, Jae Hyun Park, Jae Gahb Park
J Korean Endocr Soc. 2002;17(5):730-738.   Published online October 1, 2002
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Multiple endocrine neoplasia (MEN) type 2A is a syndrome of medullary thyroid carcinomas, pheochromocytomas and parathyroid hyperplasia. The simultaneous occurrence of medullary, and papillary, thyroid carcinomas is rare because they are derived from, apparently, different germ layers, the former from the neuroectoderm and the latter from the endoderm. We report a case of a papillary thyroid carcinoma, combined with a medullary thyroid carcinoma, in a patient with MEN type 2A. Molecular genetic studies for screening a RET proto-oncogene mutation revealed a point mutation in codon 631 on chromosome 10, which is reported as highly uncommon in MEN type 2A.
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Original Article
Completion Thyroidectomy in Patient with Differentiated Thyroid Cancer Who Initially Underwent Ipsilateral Operation.
Eun Sook Kim, Jung Min Koh, Won Bae Kim, Suck Joon Hong, Young Kee Shong
J Korean Endocr Soc. 2002;17(5):657-663.   Published online October 1, 2002
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BACKGROUND
In some instances, thyroid cancer may be diagnosed only after resection of a putative or suspected benign nodule. In these cases a complete thyroidectomy is usually recommended to prevent recurrence. We analyzed the frequency of malignancy in the contralateral lobe after a complete thyroidectomy, and assessed the factors that may predict the presence of a malignancy, which might necessitate a complete thyroidectomy. METHODS: Between 1995 and 2001, 65 patients, who initially underwent a lobectomy and isthmectomy, but were finally diagnosed with differentiated thyroid carcinoma, underwent complete thyroidectomies. Their mean age was 39.8 +/- 12.4 years, ranging, 14 to 71 years. After initial surgery, 45 proved to have follicular carcinomas, 18 papillary carcinomas, 1 medullary and 1 insular carcinoma. The mean tumor size was 4.0 +/- 1.8 cm, ranging from 0.3 to 8.5 cm. After a complete thyroidectomy, the presence of a tumor the at contralateral lobe was assessed according to clinical parameters and the pathological findings in the ipsilateral lobe. RESULTS: The first surgeries revealed tumor multifocality in 27 cases, perithyroidal tumor extension in 4 and lymph node metastasis in 1. On completion of the thyroidectomy, 22 of the 65 patients had a malignancy in the contralateral lobe. Age, sex, size or the pathological primary tumor type, were not associated with the presence of additional tumors at the contralateral lobe. Tumor multifocality at the first surgery was the only significant variable to predict the presence of a tumor in the contralateral lobe. CONCLUSION: When thyroid cancer is diagnosed after ipsilateral surgery, the only predictive factor for the presence of a contralateral tumor was multifocality. We believe that a complete thyroidectomy is mandatory in these cases.
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Case Report
Papillary Thyroid Cancer Arising in Lateral Aberrant Thyroid Presenting with Multiple Metastases.
Nam Il Cheon, Chang Hun Lee, Se In Hong, Jin Ook Chung, In Seok Yoon, Dong Hyeok Cho, Ho Cheol Kang, Dong Jin Chung, Min Young Chung
J Korean Endocr Soc. 2001;16(4-5):494-501.   Published online October 1, 2001
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Carcinoma of the thyroid usually presents as a palpable thyroid mass. However, in rare cases patients with thyroid cancer present with metastases of the cervical lymph node as the initial manifestation. The metastatic papillary tumor in cervical lymph nodes stained positive for thyroglobulin indicates the presence of a thyroid carcinoma, usually in the ipsilateral lobe. We herein report a case of multiple metastases in papillary thyroid carcinoma arising in the lateral aberrant thyroid with no evidence of thyroid carcinoma in the thyroid lobe.
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Original Article
Clinical Applications of 18-FDG PET in Recurred Differentiated Thyroid Cancer with Negative 131I Whole Body Scintigraphy: A Comparative Analysis with 99mTc-MIBI Scintigraphy.
Jong Chul Won, Sung Jin Lee, Tae Yun Lee, Il Seong Nam-Goong, Sy Yeol Lee, Ha Young Kim, Jung Hee Han, Jin Sook Ryu, Dae Hyuk Moon, Il Min Ahn
J Korean Endocr Soc. 2001;16(4-5):481-493.   Published online October 1, 2001
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BACKGROUND
In patients with differentiated thyroid cancer treated by surgery and radioactive iodine ablation, serum thyroglobulin(Tg) and 131I whole body scan(WBS) are recognized as being the best cooperative indicators for detection of recurrence or metastasis. However, in some cases, 131I WBS shows no specific lesions despite elevated serum Tg. Therefore, 18-Fluorine-fluorodeoxyglucose (FDG) positron emission tomography(PET) has emerged as a useful method for the detection of 131I WBS negative thyroid cancers. The aims of the present study are to evaluate the clinical usefulness of this technique in detection and to compare the results with 99mTc-MIBI scintigraphy(MIBI) in cases of final results being confirmed by histologic diagnosis and other imaging methods. METHODS: We conducted a retrospective analysis amon 131I WBS negative recurred papillary thyroid carcinoma patients(male: female ratio=9:22, median age=42 yr). FDG PET was performed in 28 patients and MIBI 28 patients, 25 of whom were common to both groups. All patients had histologically proven recurrence/metastasis and negative 131I WBS results but persistently elevated serum Tg levels. In each case overall clinical evaluations were performed including histology, cytology, thyroglobulin level, other imaging methods, posttherapy 131I WBS and subsequent clinical course, to allow comparison with the results of FDG PET. RESULTS: In 19 cases of patients with negative 131I WBS, proven recurrence/metastasis lesions were detected in FDG PET. Compared with MIBI, FDG PET was found to be superior in 8 cases(including 2 patients with distant metastases). No FDG-negative/MIBI-positive tumor was observed. One FDG PET negative and MIBI negative case was proven 3 months later to be metastatic cervical lymph nodes, Sensitivities were 94.7% in the FDG PET group and 52.6% in MIBI. Diagnostic accuracy of FDG PET was superior to that of MIBI(93% vs. 62%, respectively, p=0.003). CONCLUSION: Our results confirmed the clinical usefulness of FDG PET for detection of 131I negative differentiated thyroid cancers and suggested the value of FDG PET as an initial diagnostic step, rather than MIBI, in these cases.
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Case Report
Clinical Features of Well Differentiated Thyroid Carcinomas in Pregnant Women.
Seong Jin Lee, Suk Joon Hong, Pyi Ryang Lee, Young Kee Shong
J Korean Endocr Soc. 2001;16(1):140-147.   Published online February 1, 2001
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BACKGROUND
In differentiated thyroid carcinomas (DTC), it has been reported that pregnancy may accelerate the course of the disease. But recent evidences suggested that the prognosis of DTC during pregnancy was similar to that of DTC in non-pregnant women of the same age. Also the optimal timing for the treatment is still controversial. We evaluated the clinical features of DTC in pregnant women. METHOD: We reviewed the histories of patients in whom the DTC was diagnosed before or during the pregnancy between 1994 and 1999. DTC were diagnosed by fine needle aspiration and the patients were treated by thyroid surgery. RESULTS: Six women who had a mean age of 30 years (27-34 years) were identified. The mean follow-up duration was 41 months (13-70 months). All patients had noticed a lump in their necks. In three patients, the nodules increased in size during pregnancy. A fine needle aspiration revealed a suspected malignancy in five patients and a postoperative biopsy confirmed the malignancy in one patient who had a preoperative cytologic diagnosis of nodular hyperplasia. All tumors were well differentiated and ranged in size from 1 to 6.5 cm. Radioactive iodine ablation and thyroid hormone suppression treatment were administered in five patients except in one case of papillary microcarcinoma. One patient had residual tumors in the right cervical lymph nodes and both lungs. She underwent repeated surgery and radioactive iodine therapy. CONCLUSION: This reports suggest that the DTC which is associated with pregnancy may have a similar prognosis to that of non-pregnant women and that the treatment of DTC in pregnant women may be safely delayed until after delivery in most patients. The treatment should not be delayed for more than a year.
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Original Articles
Early Detection of Medullary Thyroid Cancer by Screening of the RET Proto-oncogene Germ Line Point Mutation in Family Members Affected with Hereditary Medullary Thyroid Cancer .
Sun Wook Kim, Tae Yong Kim, Young Joo Park, Won Bae Kim, Chan Soo Shin, Do Joon Park, Kyoung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2001;16(1):54-64.   Published online February 1, 2001
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BACKGROUND
Conventional biochemical screening for family members with hereditary medullary thyroid cancer (MTC) is associated with problems of sensitivity and, specificity and it frequently detects gene carriers only after disease progression. Molecular genetic screening tests that detect germ-line point mutations of the RET proto-oncogene has changed our approach to hereditary MTC. In this study we screened members of a large Korean family that had a history of hereditary MTC by a molecular genetic method and propose a therapeutic approach in managing the disorder. METHODS: Using DNA acquired from peripheral blood leukocytes of the index patient, we performed PCR and direct sequencing of exon 10 of the RET proto-oncogene. PCR-RFLP using an Mbo II restriction enzyme was performed on family members who were at risk of MTC according to the family pedigree. Basal serum calcitonin level was determined in family members who had a point mutation of the RET proto-oncogene and a pentagastrin stimulation test was performed in 3 members. RESULTS: Genetic analysis in the index case revealed a mutation in exon 10, codon 618 of the RET proto-oncogene (TGC to AGC). Out of 28 members who were at risk of MTC, 24 members participated in the screening test. 9 members tested positive for a mutation in the same chromosomal location as the index patient by PCR-RFLP. Basal serum calcitonins were above 100 pg/mL in 2 members. 3 members who had a RET point muatation but a normal basal serum calcitonin level participated in the pentagastrin stimulation test and the results were negative in all members. We found a small medullary thyroid carcinoma that had a diameter of 0.2 cm in a 16 years old boy according to a negative pentagastrin stimulation test and who had received a prophylactic total thyroidectomy. He had no evidence of a lymph node metastasis. CONCLUSION: We detected a germ-line mutation of the RET proto-oncogene in codon 618 of Exon 10 by a molecular genetic method in a family with a hereditary MTC and found 9 members that had a negative history of MTC but had a RET point mutation. There was a very small MTC found in a 16 years old boy who had a normal pentagastrin stimulation test result. Therefore, It is recommended that a prophylactic total thyroidectomy be performed as well as in members that have a mutation of the RET proto-oncogene because MTC can metastasize early in its disease course.'
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Small Medullary Thyroid Cancer Dectected by Genetic Mutation Screening in Men IIa Family.
Jae Hoon Chung, Kwang Won Kim, Ji Eun Kim, Byoung Joon Kim, Sung Hoon Kim, Kyung Ah Kim, Myung Sik Lee, Moon Gyu Lee
J Korean Endocr Soc. 1998;13(2):230-239.   Published online January 1, 2001
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Multiple endocrine neoplasia (MEN) Ila is an inherited disease characterized by the development of medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. It has been shown to be associated with germ-line mutatians in the RET proto-oncogene. Presymptomatic screening of medullary thyroid carcinoma in MEN IIa families enables the early diagnosis of this tumor with its significant morbidity, We describe a 19-year-old woman fmm a MEN IIa family who was founded by DNA analysis to be a gene carrier of MEN IIa and then was diagnosed, using a pentagastrin stimulation test, as having presymptomatie medullary thyroid carcinoma She underwent thyroidectomy and histologic examination confirmed medullary thyroid carcinoma. It is cancluded that direct genetic analysis for mutations in the RET proto-oncogene should be the diagnstlc test of choice for identifying family members at risk for MEN IIa and thyroidectomy on the basis of genetic analysis is a rational course of action.
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Endocrinol Metab : Endocrinology and Metabolism
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