Endocrinology and Metabolism

Original Article

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

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

Corrigendum

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

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Citations

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Invasiveness and Metastatic Aggressiveness in Small Differentiated Thyroid Cancers: Demography of Small Papillary Thyroid Carcinomas in the Swedish Population
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Clinical and pathologic predictors of lymph node metastasis in papillary thyroid microcarcinomas
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Annals of Diagnostic Pathology.2020; 49: 151647. CrossRef

Original Article

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

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Background

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

Methods

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

Results

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

Conclusion

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

Citations

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Editorial

Thyroid
The Biochemical Prognostic Factors of Subclinical Hypothyroidism: You Jin Lee; Endocrinol Metab. 2014;29(2):144-145. Published online June 26, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.2.144

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Original Article

Characteristics and Natural Course of Pituitary Incidentaloma in Korea.: You Jin Lee, Sun Wook Cho, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Bo Youn Cho, Hong Kyu Lee, Seong Yeon Kim; J Korean Endocr Soc. 2008;23(2):111-116. Published online April 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.2.111

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Abstract PDF

BACKGROUND
A pituitary incidentaloma is a pituitary mass discovered incidentally by computed tomography (CT) or magnetic resonance (MRI) of the brain performed for evaluation of an unrelated disease, and when the patient did not show neurological or endocrine signs and symptoms. Despite of increasing incidence, only a few studies have reported on characteristics, natural history, treatment, or follow-up strategy. Moreover no epidemiologic data exist on pituitary incidentaloma in Korean. METHODS: We retrospectively enrolled subjects diagnosed as pituitary incidentaloma in Seoul National University Hospital from January 1992 to August 2006. We reviewed baseline demographic findings and the results of basal hormone tests, visual field test, and MRI (or CT) at baseline and during follow-up. RESULTS: Among 1310 patients with pituitary adenoma, 161 subjects were diagnosed with incidentaloma. The subject age at diagnosis was 49.7 +/- 15.5 years, with 84 males. Macroadenoma was more frequent (n = 110, 68.3%). with microadenomas and Rathke's cleft cysts found in 21 and 30 cases, respectively. The mean diameter of the tumor was 1.75 cm. Functional incidentalomas such as prolactinoma or acromegaly were found in 31 cases (19.3%) although there were no symptoms or visual field defects. Of 61 incidentaloma patients who did not undergo surgery or other treatment over one year, only 3 patient showed an increase in tumor size during the mean 38.0 +/- 24.9 months follow-up. CONCLUSION: Pituitary incidentaloma generally showed a benign course despite the high prevalence of macroadenoma (68.3%). However, as about 20% of the patients had functioning tumors, pituitary hormonal evaluation at diagnosis is mandatory. Furthermore, as we experienced 3 cases with increased tumor size during follow up, including a case of pituitary microadenoma, long-term careful follow-up of pituitary incidentaloma seems necessary. A long-term, prospective study with more patients would reveal the characteristics and the natural history of pituitary incidentalomas in Korea.

Citations

Citations to this article as recorded by

Sellar Masses: An Epidemiological Study
Khaled Al-Dahmani, Syed Mohammad, Fatima Imran, Chris Theriault, Steve Doucette, Deborah Zwicker, Churn-Ern Yip, David B. Clarke, Syed Ali Imran
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.2016; 43(2): 291. CrossRef
Optimal Surgical Approaches for Rathke Cleft Cyst With Consideration of Endocrine Function
Jeong Kyung Park, Eun Jig Lee, Sun Ho Kim
Operative Neurosurgery.2012; 70: ons250. CrossRef
Clinical Characteristics of 16 Patients with Pituitary Tumor Incidentally Detected by18F-Fluorodeoxyglucose PET-CT (18F-FDG PET-CT)
Hyung Jin Kim, Gi Jeong Cheon, A Ra Cho, Chang Hoon Lee, Sang Min Youn, Se jin Ahn, Sang Eon Jang, Jung Min Kim, Yun Yong Lee, Ka Hee Yi
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Case Reports

A case of Paraganglioma Arising in the Transverse Mesocolon.: Hong Il Kim, Bo kyung Koo, You Jin Lee, Jin Taek Kim, Young Min Cho, Kuhn Uk Lee, Seong Yeon Kim; J Korean Endocr Soc. 2005;20(5):496-501. Published online October 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.5.496

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Abstract PDF

Herein, a case of a solitary primary paraganglioma arising in the mesentery, found in a hypertensive 70-year-old woman, who presented with nausea and postprandial abdominal discomfort, is reported. Ultrasonography and computed tomography showed a hypervascular mass abutting the second portion of the duodenum. An exploratory laparotomy revealed a 5.5 x 5.3 x 5cm sized mass in the mesentery of the transverse colon, which was histologically proven to be a paraganglioma. No intraoperative hemodynamic changes developed, and the postoperative course was uneventful. To our knowledge, this is the first case of a paraganglioma arising in the mesentery reported in Korea. Considering the unusual locations and the associated operative risk, it is necessary to rule out the possibility of a functioning paraganglioma in the preoperative differential diagnosis of an abdominal mass.

Citations

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Mesenteric Lesions with Similar or Distinctive Appearances on CT
Hwajin Cha, Jiyoung Hwang, Seong Sook Hong, Eun Ji Lee, Hyun-joo Kim, Yun-Woo Chang
Journal of the Korean Society of Radiology.2019; 80(6): 1091. CrossRef

A Case of Protein-losing Enteropathy with an Abnormal Cortisol Response to ACTH Stimulation.: Hong Il Kim, Bo Kyeong Koo, You Jin Lee, Eun Jung Lee, Soo Heon Kwak, Sun Wook Cho, Hyung Jin Choi, Young Min Cho, Seong Yeon Kim; J Korean Endocr Soc. 2005;20(1):90-95. Published online February 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.1.90

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Abstract PDF: We hereby report a case of a 62-year-old male patient who was misdiagnosed with adrenal insufficiency during the course of protein-losing enteropathy caused by superior mesenteric arterial thrombosis. The patient was suspected to have adrenal insufficiency due to hyponatremia and severe weakness. The cortisol responses to the initial challenge of 250microgram ACTH were inadequate (maximum serum cortisol level after ACTH challenge was 10.9microgram/dL), while the serum albumin concentration was 1.9g/dL. Subsequently, intravenous steroid therapy was given to the patient. However, after bowel resection, the serum albumin level increased to 3.4g/dL and the cortisol response to the follow-up rapid ACTH stimulation was completely normal. Accordingly, we discontinued steroid replacement and discharged the patient without any problem. In conclusion, measuring total serum cortisol in a patient with hypo-pro-teinemia may lead to misdiagnosis of adrenal insufficiency. In such cases, caution should be exercised in interpreting the results in terms of total serum cortisol level or measurement of serum free cortisol levels should be considered.

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