Endocrinology and Metabolism

Case Reports

A Case of Subsequent Papillary Carcinoma of the Thyroid gland and Hashimoto's Thyroiditis.: Sang Woong Han, Yong Seon So, Seok Hwan Kim, Ki Hyun Kwon, Tae Hyeung Kim, Jong Soon Kim, Kwang Hoe Kim, Byung Doo Lee; J Korean Endocr Soc. 1996;11(2):214-220. Published online November 7, 2019

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Abstract PDF: The association of thyroid carcinoma and Hashimotos thyroiditis in same thyroid gland is controversial. Incidence of carcinoma who has Hashimotos thyroiditis has been reported from 0.5 to 22.5 per cent by Crile and by Hirabayashi et al. The reason that there are such great diffarences in the reported incidences of carcinoma in Hashimotos disease is the result of the way the material is reported. The carcinomas of the thyroid which occur in association with Hashirnotos thyroiditis are predominently papillary tumors of lower grade malignancy. Thyroid carcinoma need not be feared in patimts with Hashimotos thymiditis, if one examines the ghmd catefully. When patients with Hashimotos disease are treated with thyroxine, there is little or no tendency for Hashimotos disease propess to clinieally detectable carcinoma of the thymid, and the microcarcinoma does not appear. In this case, single thyroid nodule was detected in Hashiimotos disease patient who was treated with thyroxine. There was no significant volume change of thyroid nodule despite of TSH suppression therapy during six months. Therefore we perforrned FNABC twice, the results were highly suspicious thyroid malignancy and subtotoal thyroidectomy was performed. The final pathologic result was microscopic papillary carcinoma with background Hashlmotos thyroiditis. In conclusion, we experienced a case of subsequent microscopic papillary carcinoma of the thyroid in patient with Hashimotos thyroiditis who was TSH suppression therapy with thyroxine.

Langerhans Cell Histiocytosis in the Thyroid and Draining Lymph Nodes: A Case Report.: Dong Hae Chung, Seung Yeon Ha, Hyun Yee Cho, Na Rae Kim, Jung Suk An, Young Don Lee, Sanghui Park; Endocrinol Metab. 2012;27(2):138-141. Published online June 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.2.138

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A 53-year-old woman was presented with several 0.3-0.6 cm-sized nodules within the right lobe of the thyroid. Histologic sections of the thyroid demonstrated multiple papillary microcarcinomas in the background of lymphocytic thyroiditis, with a small focus of Langerhans cell histiocytosis (LCH). Small LCH nodules were also found in the draining cervical lymph nodes. Although the association of LCH with papillary thyroid carcinoma in the thyroid has been reported, their co-existence with LCH in the draining lymph nodes is very rare.

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Thyroid Langerhans cell histiocytosis concurrent with papillary thyroid carcinoma: A case report and literature review
Bin Mi, Di Wu, Yue Fan, Benjamin Ka Seng Thong, Yudong Chen, Xue Wang, Chaofu Wang
Frontiers in Medicine.2023;[Epub] CrossRef
Adult Langerhans cell histiocytosis of skull in a patient with synchronous papillary thyroid carcinoma and Castleman disease
In Kyeong Kim, Kyoung Yul Lee
BMJ Case Reports.2021; 14(1): e239341. CrossRef
Langerhans cell histiocytosis of the thyroid together with papillary thyroid carcinoma
Hatice Ozisik, Banu Sarer Yurekli, Derya Demir, Yesim Ertan, Ilgın Yildirim Simsir, Murat Ozdemir, Mehmet Erdogan, Sevki Cetinkalp, Gokhan Ozgen, Fusun Saygili
Hormones.2020; 19(2): 253. CrossRef
BRAF gene mutations in synchronous papillary thyroid carcinoma and Langerhans cell histiocytosis co-existing in the thyroid gland: a case report and literature review
Mohammad A. Al Hamad, Hassan M. Albisher, Weam R. Al Saeed, Ahmed T. Almumtin, Fatimah M. Allabbad, Mohammed A. Shawarby
BMC Cancer.2019;[Epub] CrossRef
Adult Multisystem Langerhans Cell Histiocytosis Presenting with Central Diabetes Insipidus Successfully Treated with Chemotherapy
Jung-Eun Choi, Hae Ri Lee, Jung Hun Ohn, Min Kyong Moon, Juri Park, Seong Jin Lee, Moon-Gi Choi, Hyung Joon Yoo, Jung Han Kim, Eun-Gyoung Hong
Endocrinology and Metabolism.2014; 29(3): 394. CrossRef

Original Article

Comparison of Different Staging Systems for Predicting Recurrence of Papillary Thyroid Carcinoma.: Won Gu Kim, Eui Young Kim, Ji Hye Yim, Ji Min Han, Min Ji Jeon, Tae Yong Kim, Jin Sook Ryu, Gyungyub Gong, Suck Joon Hong, Won Bae Kim, Young Kee Shong; Endocrinol Metab. 2011;26(1):53-61. Published online March 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.1.53

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Abstract PDF

BACKGROUND
Various staging systems for thyroid cancer that focus on cancer specific death have been suggested, but this approach had a limitation due to the relatively long clinical course and very low rate of cancer death. This study was performed to evaluate the staging systems and to determine the most predictive staging system for predicting recurrence. METHODS: The patients who underwent first total or near total thyroidectomy due to papillary thyroid cancer (PTC) at Asan Medical Center between January 1995 and December 2001 were the subjects of this study. The commonly used 8 staging systems were applied to these subjects. Disease free survival (DFS) and the relative importance of each staging system were determined by the Kaplan-Meier method, the Cox-proportional hazards model and the proportion of variation in the survival time explained (PVE). RESULTS: A total of 952 patients (M = 117, F = 835) were enrolled and their mean age was 45 years. During a median of 10 years of follow-up, 146 (15.3%) of 952 patients had recurred tumor. The independent prognostic factors were male gender, tumor size, extrathyroidal invasion and cervical lymph node metastasis. Risk stratification according to the American thyroid association (ATA) guideline was the most predictive staging system for recurrence of PTC (PVE 88.6%). The staging systems from EORTC (PVE 79.5%), and MACIS (PVE 68.4%) had significant values for predicting recurrence of PTC. The stage of NTCTCS could not predict recurrence (PVE 4.5%, P = 0.11). CONCLUSION: Risk stratification according to the ATA was most predictive staging system for predicting recurrence of PTC. The MACIS and EORTC staging systems have good value for predicting recurrence of PTC.

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Unmet Clinical Needs in the Treatment of Patients with Thyroid Cancer
Won Bae Kim, Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Young Kee Shong
Endocrinology and Metabolism.2020; 35(1): 14. CrossRef
Impact of delayed radioiodine therapy in intermediate‐/high‐risk papillary thyroid carcinoma
Mijin Kim, Minkyu Han, Min Ji Jeon, Won Gu Kim, In Joo Kim, Jin‐Sook Ryu, Won Bae Kim, Young Kee Shong, Tae Yong Kim, Bo Hyun Kim
Clinical Endocrinology.2019; 91(3): 449. CrossRef
Clinical Value of Lymph Node Ratio Integration with the 8th Edition of the UICC TNM Classification and 2015 ATA Risk Stratification Systems for Recurrence Prediction in Papillary Thyroid Cancer
Jandee Lee, Seul Gi Lee, Kwangsoon Kim, Seung Hyuk Yim, Haengrang Ryu, Cho Rok Lee, Sang Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Young Suk Jo
Scientific Reports.2019;[Epub] CrossRef
Clinical prognostic significance of cancer stem cell markers in patients with papillary thyroid carcinoma
Yoon‑Jong Ryu, Ji‑Young Choe, Kyoungyul Lee, Soon‑Hyun Ahn
Oncology Letters.2019;[Epub] CrossRef
Dynamic Risk Stratification for Predicting Recurrence in Patients with Differentiated Thyroid Cancer Treated Without Radioactive Iodine Remnant Ablation Therapy
Suyeon Park, Won Gu Kim, Eyun Song, Hye-Seon Oh, Mijin Kim, Hyemi Kwon, Min Ji Jeon, Tae Yong Kim, Young Kee Shong, Won Bae Kim
Thyroid.2017; 27(4): 524. CrossRef
Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years?
Mijin Kim, Young Nam Kim, Won Gu Kim, Suyeon Park, Hyemi Kwon, Min Ji Jeon, Hyeon Seon Ahn, Sin-Ho Jung, Sun Wook Kim, Won Bae Kim, Jae Hoon Chung, Young Kee Shong, Tae Hyuk Kim, Tae Yong Kim
Clinical Endocrinology.2017; 86(3): 438. CrossRef
Sub-Classification of Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma by Pathologic Criteria
Min Ji Jeon, Won Gu Kim, Eun Kyung Jang, Yun Mi Choi, Dong Eun Song, Tae-Yon Sung, Jong Ho Yoon, Ki-Wook Chung, Suck Joon Hong, Jin-Sook Ryu, Ji Min Han, Tae Yong Kim, Young Kee Shong, Won Bae Kim, Konradin Metze
PLOS ONE.2015; 10(7): e0133625. CrossRef
Recent Changes in the Clinical Outcome of Papillary Thyroid Carcinoma With Cervical Lymph Node Metastasis
Min Ji Jeon, Won Gu Kim, Yun Mi Choi, Hyemi Kwon, Dong Eun Song, Yu-Mi Lee, Tae-Yon Sung, Jong Ho Yoon, Suck Joon Hong, Jung Hwan Baek, Jeong Hyun Lee, Jin-Sook Ryu, Tae Yong Kim, Young Kee Shong, Ki-Wook Chung, Won Bae Kim
The Journal of Clinical Endocrinology & Metabolism.2015; 100(9): 3470. CrossRef
Differentiating the location of cervical lymph node metastasis is very useful for estimating the risk of distant metastases in papillary thyroid carcinoma
Min Ji Jeon, Tae Yong Kim, Won Gu Kim, Ji Min Han, Eun Kyung Jang, Yun Mi Choi, Dong Eun Song, Jong Ho Yoon, Ki‐Wook Chung, Suck Joon Hong, Young Kee Shong, Won Bae Kim
Clinical Endocrinology.2014; 81(4): 593. CrossRef
Influences of Hashimoto's Thyroiditis as Prognostic Factor of Papillary Thyroid Carcinoma
Hyun Ju Park, Dong Kun Lee, Ji Won Seo, Myung Koo Kang, Heon Soo Park, Rock Bum Kim, Sung Hwan Suh, Mi Kyoung Park, Duk Kyu Kim, Jong Chul Hong
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2014; 57(5): 320. CrossRef

Case Reports

Mediastinal Uptake Misinterpreted as Metastasis in Papillary Thyroid Cancer.: Eun Kyung Lee, Kyung Won Kim, So Yeon Park, Young Joo Park, Young Tae Kim, June Key Chung, Hwa Young Cho, Yun Hyi Ku, Hee Suk Min, Seong Hoe Park, Do Joon Park, Bo Youn Cho; J Korean Endocr Soc. 2007;22(6):460-464. Published online December 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.6.460

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Abstract PDF

Radioactive iodine (RAI) therapy is used for the removal of remnant thyroid tissue or metastatic thyroid cancer cells in differentiated thyroid cancer. The main mechanism of the therapy is destruction of cells by radioactive iodine that penetrates the cells though the action of the sodium-iodide symporter (NIS). We experienced a case of a 26-year-old woman with mediastinal uptake as detected on a radioiodine scan, who was previously diagnosed with papillary thyroid cancer. For diagnostic tests including chest computed tomography (CT) and a radioiodine scan, the stimulated thyroglobulin level did not show a definite cause of the mediastinal uptake. During regular follow-up, the thymus became triangular with clear margins. The patient had neither specific symptoms nor physical findings related to the presence of a thymic mass. A subsequent CT scan showed an irregular margin of the thymus, suggestive of thymic metastasis. The patient underwent a mediastinectomy. The removed specimen was composed of normal thymic tissue. Moreover, we demonstrated the presence of human NIS by immunohistochemical analysis. After thymectomy, the mediastinal uptake was markedly decreased as compared to the previous scan. This case suggests that a clinician should be suspicious for the functional uptake of thymus when metastasis is unlikely in a clinical situation.

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Clinical Significance of Diffuse Intrathoracic Uptake on Post-Therapy I-131 Scans in Thyroid Cancer Patients
Hyun Su Choi, Sung Hoon Kim, Sonya Youngju Park, Hye Lim Park, Ye Young Seo, Woo Hee Choi
Nuclear Medicine and Molecular Imaging.2014; 48(1): 63. CrossRef

A Patient with Concurrent Medullary and Papillary Carcinoma of the Thyroid.: Seung Hee Yoo, Keun Joon Lim, Seung Hwan Lee, Ji Hyun Kim, Soon Hwa Hong, Jae Hyoung Cho, Chan Kwon Jung, Hyuk Sang Kwon, Kun Ho Yoon, Min Sik Kim, Bong Yun Cha, Ho Young Son; J Korean Endocr Soc. 2007;22(3):235-240. Published online June 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.3.235

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The origin of medullary thyroid carcinoma and papillary thyroid carcinoma are embryogenically different, so these tumors have been thought to be independent of each other. We experienced a case of concurrent medullary and papillary thyroid carcinoma in one patient. The patient underwent total thyroidectomy and both two tumors were located at different lobes, respectively. Both tumors showed their own characteristic pathologic and immunohistochemical findings. The patient's elevated calcitonin level returned to the normal range after operation and there has been no evidence of recurrence. It is still controversial whether the concurrency is just coincidental or it arises from activation of a common tumorigenic pathway.

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A Case of Concurrent Papillary and Medullary Thyroid Carcinomas Detected as Recurrent Medullary Carcinoma after Initial Surgery for Papillary Carcinoma
Dongbin Ahn, Jin Ho Sohn, Ji Young Park
Journal of Korean Thyroid Association.2013; 6(1): 80. CrossRef

Original Article

Clinical Characteristics of Poorly Differentiated Carcinoma of the Thyroid and Comparison of Its Survival to the Tall Cell and Columnar Cell Variants of Papillary Carcinoma.: Tae Sik Jung, Jae Hoon Chung, Young Lyun Oh, Tae Yong Kim, Young Kee Shong, Won Bae Kim, Kyung Won Kim, Young Joo Park, Bo Youn Cho; J Korean Endocr Soc. 2006;21(2):132-141. Published online April 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.2.132

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Abstract PDF: BACKGROUND
Poorly differentiated carcinoma (PDC) of the thyroid includes tall and columnar cell variants (TCV) of the papillary carcinoma as well as the thyroid carcinoma with trabecular, insular and solid (TIS) growth patterns. There have been a few clinical studies on the PDC of the thyroid. We evaluated the clinical characteristics and the outcome of the PDC. METHODS: We investigated the clinicopathologic features of the thyroid carcinoma with TIS growth patterns (n = 46) and TCV of the papillary carcinoma (n = 14). We investigated the clinical features of ten patients diagnosed as PDC of the thyroid who had been undergone thyroidectomy for well differentiated carcinoma previously and compared these outcome with those of patients primarily diagnosed as PDC of the thyroid (n = 60). RESULTS: The clinical course of the thyroid carcinoma with TIS growth patterns was slightly more aggressive than that of TCV of the papillary carcinoma. However, disease-specific survivals of both cancers were not significantly different. Disease-specific survival was independently correlated with the presence of distant metastasis at diagnosis and high dose radioiodine therapy. The clinical features and outcome of the patients with PDC detected at recurred sites after operation for well-differentiated carcinoma were more aggressive than those diagnosed as PDC of the thyroid. CONCLUSION: The prognosis of the thyroid carcinoma with TIS growth patterns and TCV of the papillary carcinoma were similar. The PDC which was detected after thyroidectomy for well-differentiated carcinoma had worse prognosis than primarily diagnosed as PDC of the thyroid.

Case Reports

A Case of Malignant Pleural Effusion with Pleural Metastasis in a Patient with Papillary Thyroid Carcinoma.: Ju Young Kim, Dae Won Park, Jin O Na, Byoung Yeon Hwang, Dong Lim Kim, Dong Hyun Shin, Sin Gon Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Sung Jin Cho, Nan Hee Kim; J Korean Endocr Soc. 2002;17(2):269-274. Published online April 1, 2002

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Abstract PDF: Papillary thyroid carcinomas comprise approximately 80 percent of all thyroid cancers, but haves a good prognosis, with overall survival rates at 10 years of about 80 to 95 percent. They spreads through the lymphatic system, and the lung is the most frequent metastasis site. If distant metastasis is present, the overall survival rate is about 40 percent. Although malignant pleural effusion, with pleural metastasis is a rare complication in patients with papillary thyroid carcinoma, the development of malignant pleural effusion is an extremely adverse prognostic indicator. We recently experienced a case of malignant pleural effusion with papillary thyroid carcinoma. A 54-year-old woman was admitted to the hospital because of dyspnea. A chest X-ray showed massive pleural effusion in the right hemithorax. Previously total thyroidectomy, and iodine-131 therapy had been performed, but a local recurrence and pulmonary metastasis developed 5 years later, accompanied by malignant pleural effusion with pleural metastasis. We performed diagnostic thoracentesis, which confirmed a metastatic papillary thyroid carcinoma. This patient was a rare case of paplillary thyroid carcinoma, in which the disease was represented by a rapid deterioration with malignant pleural effusion. So we report this case with a review of the literature.

Brain Metastasis from Papillary Thyroid Carcinoma: Report of 2 Cases.: Jung Gu Lee, Ki Young Lee, Yon Sil Jung, Hong Kyu Kim, Hye Young Park, Jong Ho Kim, Moon Ho Kang; J Korean Endocr Soc. 1999;14(4):745-751. Published online January 1, 2001

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Abstract PDF: Papillary carcinoma, the commonest thyroid malignancy, has an indolent clinical course and carries a good prognosis. Metastasis usually occurs to regional lymph nodes, including cervical and upper mediastinal nodes. Distant metastasis is uncommon, lung and bone being the commonest sites. Brain metastasis from papillary thyroid cancer is rare, with a frequency of less than 1% in several reported series and an extremely poor prognosis. The first case was a 74-year-old female patient with papillary cancer who took total thyroidectomy followed by 131I therapy 1 month later. Two days after 131I therapy, she developed headache, vomiting and left hemiplegia. Brain MRI and 131I whole body scan showed solitary brain metastasis in right parietal lobe. After a few weeks her condition improved enough to maintain her usual daily activity despite mild motor weakness. The second one, a 64-year-old female patient presented with headache and vomiting. Two years previously, she had taken total thyroidectomy and 131I ablation therapy after diagnosis of thyroid papillary cancer. Eight months before, she had undergone radical neck dissection because of relapse in cervical lymph nodes. Brain MRI revealed multple metastatic lesions including cerebellum. This patient did not report for follow-up after 2 months of discharge.

Original Articles

Concurrent Medullay and Papillary Carcinoma of the Thyroid.: Seok Jun Hong, Kyung Yub Gong, Young Ki Song, Jin Sook Ryu, Ki Soo Kim, Jung Hee Lee; J Korean Endocr Soc. 1998;13(4):634-639. Published online January 1, 2001

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Abstract PDF: The origins of medullary carcinoma and papillary carcinoma of thyroid are embryologically different. We report a case of simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid in the same thyroid gland. In this case, the occurrence of the two tumors may be a coincidence, does not have embryological or genetical significance.

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.

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