Endocrinology and Metabolism

Original Article

Thyroid
Risk of Malignancy in Thyroid Incidentalomas Identified by Fluorodeoxyglucose-Positron Emission Tomography: A Reum Chun, Hye Min Jo, Seoung Ho Lee, Hong Woo Chun, Jung Mi Park, Kyu Jin Kim, Chan Hee Jung, Ji Oh Mok, Sung Koo Kang, Chul Hee Kim, Bo Yeon Kim; Endocrinol Metab. 2015;30(1):71-77. Published online March 27, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.1.71

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Background

Thyroid incidentalomas detected by 2-deoxy-2-¹⁸F-fluoro-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) have been reported in 1% to 4% of the population, with a risk of malignancy of 27.8% to 74%. We performed a retrospective review of FDG-avid thyroid incidentalomas in cancer screening subjects and patients with nonthyroid cancer. The risk of malignancy in thyroid incidentaloma and its association with the maximal standardized uptake value (SUV_max) in ¹⁸F-FDG PET/CT were evaluated to define the predictor variables in assessing risk of malignancy.

Methods

A total of 2,584 subjects underwent ¹⁸F-FDG PET/CT for metastatic evaluation or cancer screening from January 2005 to January 2010. Among them, 36 subjects with FDG-avid thyroid incidentalomas underwent further diagnostic evaluation (thyroid ultrasonography-guided fine needle aspiration cytology [FNAC] or surgical resection). We retrospectively reviewed the database of these subjects.

Results

Of the 2,584 subjects who underwent ¹⁸F-FDG PET/CT (319 for cancer screening and 2,265 for metastatic evaluation), 52 (2.0%) were identified as having FDG-avid thyroid incidentaloma and cytologic diagnosis was obtained by FNAC in 36 subjects. Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection. The positive predictive value of malignancy in FDG-avid thyroid incidentaloma was 41.7%. Median SUV_max was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001).

Conclusion

Thyroid incidentalomas found on ¹⁸F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%. FDG-avid thyroid incidentalomas with higher SUV_max tended to be malignant.

Citations

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Is TI-RADS classification and Score Modified Method of thyroid nodules can be effective for evaluation of Thyroid Incidentalomas on FDG PET-CT imaging
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Case Reports

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

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

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

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Abstract PDF

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

Citations

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

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

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Abstract PDF

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

Citations

Citations to this article as recorded by

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

Original Article

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

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

Case Reports

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

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

A Case of Brown Tumor with Severe Hypercalcemia Caused by Parathyroid Adenoma.: Ji Oh Mok; J Korean Endocr Soc. 2003;18(2):221-226. Published online April 1, 2003

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Abstract PDF: Most of primary hyperparathyroidism results from parathyroid adenoma, and is characterized by hypercalcemia, reduced bone density, frequent renal stone, gastric ulcer, duodenal ulcer, muscle weakness, depression, hypertension, anemia, and rarely brown tumor. We had a case of an 80-year-old man having brown tumor caused by primary hyperparathyroidism on the right 10th rib confirmed by CT guided bone biopsy. The patient presented with decreased level of consciousness, acute gastric ulcer, acute duodenal ulcer, GB stones, renal insufficiency, depression, and osteoporosis. Serum calcium level was 16.7 mg/dL and the intact parathyroid hormone level was 3901pg/mL. A parathyroid mass was detected by neck CT and 99mTc-tetrofosmin parathyroid scan. The parathyroid tumor was removed and confirmed as a parathyroid adenoma by pathology. After operation, the patient was treated with vitamin D and calcium in response to the resulting hungry bone syndrome. The intact PTH level returned to a normal range after the removal of the parathyroid adenoma.

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