Endocrinology and Metabolism

Review Articles

Thyroid
Management of Subclinical Hypothyroidism: A Focus on Proven Health Effects in the 2023 Korean Thyroid Association Guidelines: Eu Jeong Ku, Won Sang Yoo, Hyun Kyung Chung; Endocrinol Metab. 2023;38(4):381-391. Published online August 8, 2023; DOI: https://doi.org/10.3803/EnM.2023.1778

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Subclinical hypothyroidism (SCH) is characterized by elevated thyroid-stimulating hormone (TSH) and normal free thyroxine levels. The Korean Thyroid Association recently issued a guideline for managing SCH, which emphasizes Korean-specific TSH diagnostic criteria and highlights the health benefits of levothyroxine (LT4) treatment. A serum TSH level of 6.8 mIU/L is presented as the reference value for diagnosing SCH. SCH can be classified as mild (TSH 6.8 to 10.0 mIU/L) or severe (TSH >10.0 mIU/L), and patients can be categorized as adults (age <70 years) or elderly (age ≥70 years), depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, including a thyroid peroxidase antibody test, preferably 2 to 3 months after the initial assessment. While LT4 treatment is not generally recommended for mild SCH in adults, it is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and it may be considered for those with concurrent dyslipidemia. Conversely, LT4 treatment is generally not recommended for elderly patients, regardless of SCH severity. For those SCH patients who are prescribed LT4 treatment, the dosage should be personalized, and serum TSH levels should be regularly monitored to maintain the optimal LT4 regimen.

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Clinical Implications of Different Thyroid-Stimulating Hormone (TSH) Reference Intervals between TSH Kits for the Management of Subclinical Hypothyroidism
Won Sang Yoo
Endocrinology and Metabolism.2024; 39(1): 188. CrossRef

Thyroid
Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape: Won Sang Yoo, Hyun Kyung Chung; Endocrinol Metab. 2021;36(3):500-513. Published online June 18, 2021; DOI: https://doi.org/10.3803/EnM.2021.1066

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Abstract PDF PubReader ePub

Subclinical hypothyroidism (sHypo) is defined as normal serum free thyroid hormone levels coexisting with elevated serum thyroid-stimulating hormone (TSH) levels. sHypo is a common condition observed in clinical practice with several unique features. Its diagnosis should be based on an understanding of geographic and demographic differences in biochemical criteria versus a global reference range for TSH that is based on the 95% confidence interval of a healthy population. During the differential diagnosis, it is important to remember that a considerable proportion of sHypo cases are transient and reversible in nature; the focus is better placed on persistent or progressive forms, which mainly result from chronic autoimmune thyroiditis. Despite significant evidence documenting the health impacts of sHypo, the effects of levothyroxine treatment (LT4-Tx) in patients with sHypo remains controversial, especially in patients with grade 1 sHypo and older adults. Existing evidence suggests that it is reasonable to refrain from immediate LT4-Tx in most patients if they are closely monitored, except in women who are pregnant or in progressive cases. Future research is needed to further characterize the risks and benefits of LT4-Tx in different patient cohorts.

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THYROID FUNCTION ABNORMALITIES IN PATIENTS WITH CHOLELITHIASIS: A HOSPITAL-BASED CROSS-SECTIONAL STUDY
AVANISH KUMAR SAXENA, ANAM FATIMA, KUNDRAPU VEERA VENKATA SIVA, ANUSHKA PARIYA, VAYALAPALLI SYAMA CHINMAYI
Asian Journal of Pharmaceutical and Clinical Research.2024; : 138. CrossRef
Subclinical hypothyroidism and clinical outcomes after cardiac surgery: A systematic review and meta-analysis
Michele Dell’Aquila, Camilla S. Rossi, Tulio Caldonazo, Gianmarco Cancelli, Lamia Harik, Giovanni J. Soletti, Kevin R. An, Jordan Leith, Hristo Kirov, Mudathir Ibrahim, Michelle Demetres, Arnaldo Dimagli, Mohamed Rahouma, Mario Gaudino
JTCVS Open.2024; 18: 64. CrossRef
The Relationship between Subclinical Hypothyroidism and Carotid Intima-Media Thickness as a Potential Marker of Cardiovascular Risk: A Systematic Review and a Meta-Analysis
Oana-Maria Isailă, Victor Eduard Stoian, Iuliu Fulga, Alin-Ionut Piraianu, Sorin Hostiuc
Journal of Cardiovascular Development and Disease.2024; 11(4): 98. CrossRef
Variability of Thyroid Hormones in Newborns from Mothers with Endemic Goiter
Turdieva Shokhida Tolkunovna, Ganieva Durdona Kamalovna
Journal of Nature and Science of Medicine.2024; 7(2): 129. CrossRef
Thyroid dysfunction in the ageing patient
O.V. Bilookyi, V.L. Vasiuk, O.A. Shupik
INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2024; 20(2): 143. CrossRef
Hormonal influences on cerebral aneurysms: unraveling the complex connections
Zahra Hasanpour Segherlou, Mahdieh Shakeri, Armin Khavandegar, Sara Stephenson, Kimberly Ciccone, Forough Masheghati, Mohammad Reza Hosseini Siyanaki, Mac Lyerly, Brandon Lucke-Wold
Expert Review of Endocrinology & Metabolism.2024;[Epub] CrossRef
Subclinical hypothyroidism, outcomes and management guidelines: a narrative review and update of recent literature
Bogumila Urgatz, Salman Razvi
Current Medical Research and Opinion.2023; 39(3): 351. CrossRef
Indicator of thyroid hormones in newborns from mothers with diffuse-endemic goiter
G. T. Makhkamova, Sh. T. Turdieva
Meditsinskiy sovet = Medical Council.2023; (1): 212. CrossRef
Diagnóstico y tratamiento del hipotiroidismo subclínico en adultos mayores
Debbie Noelia Tebanta Albán, Gabriel Aníbal Hugo Merino, María Valentina Muñoz Arteaga, Ariana Lisseth Vázquez López
Ciencia Digital.2023; 7(1): 6. CrossRef
2023 Korean Thyroid Association Management Guidelines for Patients with Subclinical Hypothyroidism
Hyun Kyung Chung, Eu Jeong Ku, Won Sang Yoo, Yea Eun Kang, Kyeong Jin Kim, Bo Hyun Kim, Tae-Yong Kim, Young Joo Park, Chang Ho Ahn, Jee Hee Yoon, Eun Kyung Lee, Jong Min Lee, Eui Dal Jung, Jae Hoon Chung, Yun Jae Chung, Won Bae Kim, Ka Hee Yi, Ho-Cheol Ka
International Journal of Thyroidology.2023; 16(1): 32. CrossRef
Gut microbiota short-chain fatty acids and their impact on the host thyroid function and diseases
María José Mendoza-León, Ashutosh K. Mangalam, Alejandro Regaldiz, Enrique González-Madrid, Ma. Andreina Rangel-Ramírez, Oscar Álvarez-Mardonez, Omar P. Vallejos, Constanza Méndez, Susan M. Bueno, Felipe Melo-González, Yorley Duarte, Ma. Cecilia Opazo, Al
Frontiers in Endocrinology.2023;[Epub] CrossRef
Human amnion-derived mesenchymal stem cells improve subclinical hypothyroidism by immunocompetence mediating apoptosis inhibition on thyroid cells in aged mice
Chuyu Li, Qiang Rui, Xiaohan Dong, Song Ning, Jing Zhou, Huimin Wu, Chunyan Jiang, Yugui Cui, Jiayin Liu, Jun Jiang, Lianju Qin
Cell and Tissue Research.2023; 394(2): 309. CrossRef
Is Thyroid Dysfunction Associated with Unruptured Intracranial Aneurysms? A Population-Based, Nested Case–Control Study from Korea
Hyeree Park, Sun Wook Cho, Sung Ho Lee, Kangmin Kim, Hyun-Seung Kang, Jeong Eun Kim, Aesun Shin, Won-Sang Cho
Thyroid®.2023; 33(12): 1483. CrossRef
The Role of Global Longitudinal Strain in Subclinical Hypothyroid Patients With Heart Failure
Nismat Javed, Vibha Hayagreev, Angel DeLaCruz, Muhammad Saad, Amandeep Singh, Timothy Vittorio
Cureus.2023;[Epub] CrossRef
Association between shift work and the risk of hypothyroidism in adult male workers in Korea: a cohort study
Seonghyeon Kwon, Yesung Lee, Eunhye Seo, Daehoon Kim, Jaehong Lee, Youshik Jeong, Jihoon Kim, Jinsook Jeong, Woncheol Lee
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef
Estimation of left ventricular functions in patients with subclinical hypothyroidism: a meta-analysis
Binyi Li, Yong Huang, Zheng Li
Frontiers in Endocrinology.2023;[Epub] CrossRef
Comparison of Five Different Criteria for Diagnosis of Subclinical Hypothyroidism in a Large-Scale Chinese Population
Yan-song Zheng, Sheng-yong Dong, Yan Gong, Jia-hong Wang, Fei Wang, Qiang Zeng
Frontiers in Endocrinology.2022;[Epub] CrossRef
Subclinical Hypothyroidism and Cognitive Impairment
Jung-Min Pyun, Young Ho Park, SangYun Kim
Journal of Alzheimer's Disease.2022; 88(2): 757. CrossRef
Effect of Levothyroxine Supplementation on the Cardiac Morphology and Function in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis
Xichang Wang, Haoyu Wang, Qiuxian Li, Ping Wang, Yumin Xing, Fan Zhang, Jiashu Li, Zhongyan Shan
The Journal of Clinical Endocrinology & Metabolism.2022; 107(9): 2674. CrossRef
Natural history of subclinical hypothyroidism and prognostic factors for the development of overt hypothyroidism: Tehran Thyroid Study (TTS)
A. Amouzegar, M. Dehghani, H. Abdi, L. Mehran, S. Masoumi, F. Azizi
Journal of Endocrinological Investigation.2022; 45(12): 2353. CrossRef
Retrospective cohort analysis comparing changes in blood glucose level and body composition according to changes in thyroid‐stimulating hormone level
Hyunah Kim, Da Young Jung, Seung‐Hwan Lee, Jae‐Hyoung Cho, Hyeon Woo Yim, Hun‐Sung Kim
Journal of Diabetes.2022; 14(9): 620. CrossRef
Long working hours and the risk of hypothyroidism in healthy Korean workers: a cohort study
Yesung Lee, Woncheol Lee, Hyoung-Ryoul Kim
Epidemiology and Health.2022; 44: e2022104. CrossRef

Original Article

The Incidence of Thyroid Autoantibody in Subacute Thyroiditis and the Clinical Characteristics of Greeping Thyroiditis.: Jae Seok Jeon, Won Bae Kim, Hae Young Park, Young Joo Park, Hyun Kyung Chung, Sang Jeon Choi, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh; J Korean Endocr Soc. 1996;11(4):438-446. Published online November 7, 2019

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Abstract PDF: Background
Subacute thyroiditis is a spontaneously resolving inflammatory disorder of thyroid gland, usually associated with painful goiter and short-lived thyrotoxicosis. Although its etiology is yet to be established, much evidence suggests viral infections and genetic factors play important roles. Usually, both lobes of thyroid gland are involved simultaneously, but in some patients one lobe is involved first and the other later(creeping thyroiditis), Thyroid autoantibodies which might appear probably due to inflammatory release of thyroid antigens, are found in a variable number of patients with subacute thyroiditis. However there have been few detailed reports on their incidence in Korean patients with subacute thyroiditis. So, we were to see the elinical characteristics of patients with subacute thyroiditis with special regards to the incidence of thyroid autoantibodies and to the incidence and characteristics of creeping thyroiditis, Methods: We reviewed the clinical records of 85 patients with subacute thyroiditis(7 men and 78 wornen, meam age of 43+9 years) who had visited the thyroid clinic in Seoul National University Hospital between 1986 and 1994. Results: At initial visit, the incidenees of thyroid autoantibodies were as follows: anti- microsomal antibody 7.8%, anti-thyroglobulin antibody 22.1%, and thyratropin binding inhibitor inununglobulin 6.3%. During the follow-up period, thyroid autoantibodies appeared most frequently between the first and the second month after initial visit. Compared to those with non-creeping thyroiditis, the patients with creeping thyroiditis(21.4%) had nonspecific systemic sy~rnptoms more frequently(89% vs. 42%, p<0.05). They required steroid therapy more ftequently(89% vs. 52%, p <0.05), and needed longer duration of treatment(9.3+6.2weeks vs, 4.7+3.7weeks, p<0.05). The incidence of abnormalities in liver function and the incidence of thyroid autoantibodies were higher in non-creeping thyroiditis group. Conclusion: In accordance with previous reports, thyroid autoantibodies were detected in only a small portion of Korean patients with subacute thyroiditis. Rather different clinical manifestations and different incidences of thyroid autoantibodies between ereeping group and non-creeping group suggest differences in the pathogenetic mechanisms between those two groups. However, there is need for further study to validate such observation and to elucidate the mechanisms.

Review Article

Thyroid
Recent Advances in Autoimmune Thyroid Diseases: Won Sang Yoo, Hyun Kyung Chung; Endocrinol Metab. 2016;31(3):379-385. Published online August 26, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.379

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Autoimmune thyroid disease (AITD) includes hyperthyroid Graves disease, hypothyroid autoimmune thyroiditis, and subtle subclinical thyroid dysfunctions. AITD is caused by interactions between genetic and environmental predisposing factors and results in autoimmune deterioration. Data on polymorphisms in the AITD susceptibility genes, related environmental factors, and dysregulation of autoimmune processes have accumulated over time. Over the last decade, there has been progress in the clinical field of AITD with respect to the available diagnostic and therapeutic methods as well as clinical consensus. The updated clinical guidelines allow practitioners to identify the most reasonable and current approaches for proper management. In this review, we focus on recent advances in understanding the genetic and environmental pathogenic mechanisms underlying AITD and introduce the updated set of clinical guidelines for AITD management. We also discuss other aspects of the disease such as management of subclinical thyroid dysfunction, use of levothyroxine plus levotriiodothyronine in the treatment of autoimmune hypothyroidism, risk assessment of long-standing antithyroid drug therapy in recurrent Graves' hyperthyroidism, and future research needs.

Citations

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World of Medicine and Biology.2023; 19(84): 139. CrossRef
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Sun Wook Cho, Young Joo Park
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Incidence and Clinical Implications of Autoimmune Thyroiditis in the Development of Acne in Young Patients
Laura Endres, Delia Mirela Tit, Simona Bungau, Nicoleta Anamaria Pascalau, Laura Maghiar Țodan, Erika Bimbo-Szuhai, Gabriela Mariana Iancu, Nicoleta Negrut
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Larissa Barros Pinto Franco, Fernanda Neves Pinto, Claudia Teresa Bento, Carla Viana Dendasck
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Editorial

Environmental Factors and Thyroid Dysfunction.: Hyun Kyung Chung; Endocrinol Metab. 2012;27(3):191-193. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.191

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Abstract PDF

No abstract available.

Citations

Citations to this article as recorded by

A study on the health effects of residents in Namhae and Hadong - Centered on health insurance data
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Journal of Odor and Indoor Environment.2020; 19(3): 268. CrossRef
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The Biochemical Prognostic Factors of Subclinical Hypothyroidism
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Letter

Letter: The Association between Type 2 Diabetes Mellitus and Colorectal Cancer.: Hyun Kyung Chung; Endocrinol Metab. 2011;26(4):364. Published online December 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.4.364

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Abstract PDF: No abstract available.

Case Reports

Reversible Heart Failure and Rhabdomyolysis Caused by Primary Hypoparathyroidism during Lactation.: Kyongyeun Jung, Jeong Hyun Choi, Hee Jin Kim, Hyun Kyung Chung, Dohee Kim; Endocrinol Metab. 2011;26(3):268-271. Published online September 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.3.268

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Abstract PDF: Hypocalcemia can be complicated, on rare occasions, by congestive heart failure and may also be associated with labor and lactation in some cases. Herein, we report a 30-year-old woman with hypocalcemia-induced heart failure secondary to primary idiopathic hypoparathyroidism precipitated by lactation. The patient presented with chest pain and paresthesia in both arms and legs during breast-feeding after her second delivery. She had severe hypocalcemia and low parathyroid hormone levels. Hypocalcemia-induced rhabdomyolysis further aggravated her hypocalcemia symptoms. The echocardiogram showed global hypokinesia with an ejection fraction of 47%. After calcium and vitamin D replacement, her symptoms and ventricular function improved. Hypocalcemia needs to be considered in patients with heart failure, because it is readily reversible. To the best of our knowledge, this is the first report of a patient with heart failure and rhabdomyolysis induced by primary hypoparathyroidism during lactation.

Intrathyroidal Metastasis of Lung Adenocarcinoma Presenting as Subacute Thyroiditis.: Hyun Sung Shin, Young Kwang Choo, Won Ae Lee, Hyun Kyung Chung; Endocrinol Metab. 2010;25(3):226-230. Published online September 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.3.226

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Abstract PDF: One of the rare diseases for differential diagnosis of subacute thyroiditis is metastases within the thyroid gland. We report here on a 72-year-old-woman with painful goiter and signs of hyperthyroidism. Her serum concentration of thyroid hormone was in the upper limit of normal, and the uptake of radioactive iodine by the thyroid was completely depressed. Although subacute thyroiditis was suspected, an additional work up that included a chest CT scan was done for the combined cough and chronic weakness. The result was lung cancer with metastatic involvement of the thyroid and multiple lymph nodes. She refused further anti-cancer therapy and died 5 months after the diagnosis. For the differential diagnosis of such a rare case, careful examination is important even in patients with the typical symptoms and laboratory findings of subacute thyroiditis.

Spontaneous Pregnancy and Delivery in a Patient with Sheehan's Syndrome.: Young Kwang Choo, Won Sang Yoo, Do Hee Kim, Hyun Kyung Chung, Hee Jin Kim; J Korean Endocr Soc. 2009;24(2):121-125. Published online June 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.2.121

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Abstract PDF

Sheehan's syndrome is postpartum hypopituitarism due to the necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with Sheehan's syndrome have varying degrees of anterior pituitary hormone deficiency. They are accompanied with amenorrhea and ovulation dysfunction, and so they rarely get pregnant naturally. Ovulation induction is necessary if these patients desire to become pregnant. However, spontaneous pregnancy may be possible in some patients who have a preserved gonadotrophin reserve. We experienced a case of 29-year-old woman who was diagnosed Sheehan's syndrome 20 months after delivery and we medicated her with prednisolone and thyroxine. She got pregnant spontaneously after 18 months of hormone replacement therapy although she had amenorrhea and irregular menstrual cycles. She successfully delivered a baby by cesarean section. Here we report on this case with a review of the relevant literature concerned with pregnancy and Sheehan's syndrome.

Citations

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Acute Sheehan’s Syndrome Associated with Postpartum Hemorrhage
Deokkyeong Kim, Jiwon Min, Yun-Sook Kim, Aeli Ryu
Soonchunhyang Medical Science.2017; 23(1): 65. 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; J Korean Endocr Soc. 2007;22(6):453-459. Published online December 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.6.453

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Abstract PDF

Multiple endocrine neoplasia type 2A (MEN2A) is an autosomal dominant syndrome characterized by the presence of a medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. MEN2A arises due to germline missense mutations of the RET proto-oncogene. Specific RET mutations correlate with the onset of age and the aggressiveness of a medullary thyroid carcinoma. However, the clinical presentation varies even within families, where patients carry the same mutation. Recently, it has been reported that polymorphisms of RET may have a modifier effect on the presentation. We experienced a case of 42-year-old man, whose bilateral pheochromocytoma and medullary thyroid carcinoma were incidentally found. Genetic testing detected a mutation in codon 634 (C634R) and a polymorphism in codon 691 (G691S) of the RET proto-oncogene. His mother, younger brother and his only son had the same mutation and polymorphism. We report this case with a review of the literature about RET gene polymorphisms.

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A Family Presenting with Catastrophic Features due to Pheochromocytoma Associated with Multiple Endocrine Neoplasia 2A
Yun Jung Lee, Suk Chon, Sang-Ho Lee, Tae-Won Lee, Chun-Gyoo Ihm, Tae June Noh, Seungjoon Oh, Jeong-Taek Woo, Sung-Woon Kim, Jin-Woo Kim, Young Seol Kim
Endocrinology and Metabolism.2010; 25(2): 135. CrossRef
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
Journal of Korean Endocrine Society.2009; 24(4): 293. CrossRef

Original Articles

Effect of High Concentration of Estradiol on Thyroid Specific Genes Expression and Cell Growth.: Dong Woo Kim, Hee Youn Park, Do Hee Kim, Hee Jin Kim, Hyun Kyung Chung; J Korean Endocr Soc. 2006;21(1):32-39. Published online February 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.1.32

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Abstract PDF: BACKGROUND
Since various thyroid diseases have dominant prevalence in women, it has been suggested that female sex hormone have important role on thyroid cell physiology. Interestingly, many thyroid disorders are newly diagnosed or changed their course around the period of high estrogen status, such as pregnancy. In this study, we questioned whether high concentration of estrogen could modulate thyroid cell function. METHODS: We treated normal rat thyroid FRTL-5 cell line with different time and concentration of estradiol. Using cell count, FACscan, and Northern blot analysis, we compared the changes of cell growth, cell cycle progression and thyroid specific genes expression. To evaluate the influence of thyroid stimulating hormone (TSH), all experiment was designed as two different sets, with (6H) or without TSH (5H). RESULTS: The concentration of 10-1000 nM estradiol had definite stimulatory function on thyroid cell growth in 5H condition as concentration dependent manner. FACscan revealed the increased cell growths were related to G1/S progression. The Pax-8, TTF-1 and NIS gene expressions were dramatically increased in 10-1000 nM of estradiol, too. With TSH (6H), however, we could not find any cell growth stimulating effects with 10-1000 nM of estradiol. CONCLUSION: High concentration of estradiol is one of important control factor for thyroid growth and thyroid specific genes expression, especially in 5H condition. It indicate that exposure to high concentration of female sex hormone, such as pregnancy, can be a direct stimulating factor to various thyroid function and related to autoimmune or nodular thyroid diseases around the period of pregnancy.

Prevalence Thyroid Cancer in Patients with Cold Thyroid Nodules in Relation to Sex, Age, And Multinodularity.: Won Bae Kim, Hyun Kyung Chung, Chang Hoon Yim, Do Joon Park, Sung Yeon Kim, Bo Yeon Cho, Hong Gyu Lee; J Korean Endocr Soc. 1998;13(3):366-372. Published online January 1, 2001

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Abstract PDF: BACKGROUND
We evaluated the prevalence of thyroid cancer in patients with cold thyroid nodules and the impact of sex, age, hardness of nodule, and multinodularity as factors able to predict the probability of malignancy in patients with nodular thyroid diseases. METHODS: We examined a 728 patients who visited Seoul National University Hospital with one or more cold thyroid nodules between Jan. 1996 and Dec. 1997. After clinical evaluations including medical history, physical examinations(size, hardness and multiplicity of nodule), fine needle aspiration biopsies and cytologic examinations were carried out. RESULTS: Among the 728 cases, 76 cases(10.4%) were diagnosed as cancer and 602 cases (82.6%) were diagnosed as benign nodule. The prevalence of cancer was significantly lower in female patients with cold nodules(9.4%, 62/662) than in males(17.5%, 11/63)(p=0.041). Age was an important factor in both sexes. The proportion of nodules that were malignant was lower in patients of 20-60 years old(8,9%, 56/632) than patients younger than 20 years old(1S.1%, 2/11) or older than 60 years old(18.3%, 15/82)(p=0.019). The prevalence of cancer was significantly higher in hard nodules(36.3%, 41/113) than firm(5.2%, 30/574) or soft nodules(5.3%, 2/38)(p= 0.001). There was no size difference between malignant(25.2 +- 13.7mm) and benign nodules(25.3 +- 8.9mm)(p=0.9425). The prevalence of thyroid cancer in solitary nodule(10.6%, 63/593) was not different from that in multiple nodules(7.6%, 10/132)(p=0.293). CONCLUSION: Our data suggest that thyroid nodules of the patients who are younger than 20 years old or older than 60 years old, male, as well as hard nodule require more careful evaluation for the risk of thyroid malignancies.

Usefulness of Immunoglobulin Fraction Precipitated with Polyethylene Glycol in Assay for TSH Receptor Antibodies using Chinese Hamster Overy Cells Expressing Human TSH Receptors.: Won Bae Kim, Hyun Kyung Chung, Chang Soon Koh, Chang Hoon Yim, Do Joon Park, Bo Yeon Cho, Hong Gyu Lee; J Korean Endocr Soc. 1998;13(2):167-180. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Graves' disease and primary myxedema are thought to be caused by the action of TSH receptor autoantibodies(thyroid stimulating antibody; TSAb & thyroid stimulation blocking antibody; TSBAb). Thus, detection of these antibodies is crucial in diagnosis and in follow up of those patients. Recently, a sensitive method using human TSH receptor transfected Chinese Hamster Ovary(CHO) cells has been developed. However, the complexity of IgG purification procedure is considered as a limitation for its clinical application as a routine test. The aim of this study is to determine whether polyethylene glycol(PEG)-precipitated immunogiobuIin fraction could substitute for purified IgG. METHODS: We developed optimal conditions for TSAb and TSBAb assays using crude, PEG precipitated immunoglobulin fraction; and evaluated the correlation of TSAb and TSBAb activities between thase measured using crude immunoglobulin fraction and purified IgG to clarify the usefulness of PEG-precipitated immunoglobulin fraction. TSH receptor expressing wild type CHO cells were used in TSAb and CHO cells expressing chimeric TSH receptor(Mc2; 90-165 amino acid residues were substituted by those of rat LH/CG receptar) were used in TSBAb assay to minimize the possible disturbing effects of TSAb in serum. RESULTS: The optimal serum amount for TSAb and TSBAb assay using PEG-precipitated immunoglobulin fraction were 250mL serum equivalent/well and 50mL serum equivalent/well, respectively. The optimal incubation time for both assays were 2 homs, and aptimal ccrncentration of bTSH for TSBAb assay was 0.1U/L. TSAb activities measured with PEG-precipitated immunoglobulin were significantly correlated with those measured with purified IgG in 26 patients with Graves diseases(r=0.93, p<0.001). Although TSBAb activities measured using PEG-precipitated imrnunoglobulin were conelated with those measured using purified IgG in 20 patients with primary myxedema(r=0.86, p<0.001), the positive rate in TSBAb assay using PEG-precipitated immunoglobulin was lower than that of usmg purified IgG(20% v.s. 65%) because of negative conversion of TSBAb activities in samples with weakly positive TSBAb activities measured using purified IgG. CONCLUSION: PEG-precipitated immunoglobulin fraction could be used instead of purified IgG in TSAb assay using hTSHR-tranasfected wild type CHO cells with equal sensitivity and specificity. This simple and practical TSAb assay using PEG-precipitated immunoglobulin in hTSHR-transfected CHO cells would be useful in clinica1 practiee.

Analysis of Prognostic Factors Determining the Recurrences in Patients with Papillary Thyroid Cancer After Surgical Treatment.: Jae Seok Jeon, Won Bae Kim, Hyun Kyung Chung, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Do Joon Park, Sun Wook Kim; J Korean Endocr Soc. 1997;12(3):421-432. Published online January 1, 2001

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Abstract PDF: BACKGROUND
It is important to recognize the independent prognostic factors of papillary carcinoma of thyroid in therapeutic and follow up planning. However, its good prognosis and its low prevalence make it difficult to analyze prognostic factors determining patients survival in a relatively short period of time. We retrospectively investigated the independent prognostic factors for determining disease recurrence after surgery which, in adults, are known to be closely related to the prognosis of cancer. METHOD: We retrospectively reviewed the clinical records of 456 patients (male 70, female 381, unknown 5, mean age of 43.9+-12.9 years) who had visited the thyroid clinic in Seoul National University Hospital and analyzed the data with statistical software program. RESULTS: 1) At initial visit, chief complaint of the patients was abnormal neck mass in 90 percent. 2) In preoperative thyroid scan study, 82% showed cold area and 16% showed diffuse enlargement. 3) Of the 50 recurrent cases after surgery (11.5% of the total cases), 39 cases (78%) had recurred disease in neck area and 11 cases (22%) had recurrences at distant sites. (Lung 9 cases, Brain I case, Mediastinum 1case) 4) Statistically significant risk factors for recurrence after surgery were male sex, size of tumor (above 4.5cm in this study), extrathyroidal invasion of cancer, involvement of resection margin and no remnant ablation of thyroid tissue using radioiodine. CONCLUSION: Through retrospective study, we presented some clinical characteristics of papillary thyroid cancer in Korea and independent risk factors of cancer recurrences after surgery.

Changes in Properties of Thyrotropin Receptor Antibodies Following Radioiodine Treatment in Patients with Graves' Disease.: Won Bae Kim, Hyun Kyung Chung, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Do Joon Park, Yeon Sahng Oh; J Korean Endocr Soc. 1997;12(2):194-206. Published online January 1, 2001

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Abstract PDF: BACKGROUND
It has been suggested that thyroid stimulation blocking antibody (TSBAb) is involved in the development of early hypothyroidism after radioiodine treatment in patient with Graves disease. However, previous studies have reported the effect of radioiodine treatment on overall changes of TSH receptor antibodies without detailed observation of changes in properties of TSH receptor antibodies. The aim of this study is to evaluate the effect of radioiodine treatment on thyroid stimulation antibody (TSAb) or on thyroid stimulation blocking antibody (TSBAb) activities and to see whether the appearance of TSBAb after radioiodine treatment is involved in the development of early hypothyroidism in patients with Graves disease. METHODS: The activities of TSAb, TSBAb were measured serially with human TSH receptor transfected Chinese hamster ovary (CHO) cells in 36 patients with Graves disease who received 131I treatment. In addition to the wild type TSH receptor-expressing cells, we used a chimeric receptor that 90-165 amino acid residues were substituted by those of rat LH/CG receptor (Mc2) for measurement of TSBAb without interference by the presence of TSAb and for evaluation of TSAb epitope spreading. We evaluated the association of early hypothyroidism after 131I treatment with changes of various immunologic parameters. RESULTS: In 14 (39%) of 36 patients, TSBAb activities were present in their sera before or after 131I treatment. Four of them had TSBAb activities before 131 treatment, and 12 newly acquired TSBAb activities after 131I treatment. The existence of TSBAb was not associated with the development of early hypothyroidism after 131I treatment but with low TSAb activities before 131 treatment, high thyroidal uptake of 131I given and with old age. The phenomena of epitope spreading measured by TSAb with Mc2 mutant clone before and after 131I treatment was not infrequent, but it had no clinical relevance. CONCLUSION: These results suggest that the existence of TSBAb may be not a major factor in the development of early hypothyroidism after radioiodine treatment in Graves disease. Other factors such as TSAb activities before radioiodine treatment, the efficiency of thyroidal uptake of 131I or old age are associated with the development of early hypothyroidism.

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