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Ahn HY. Subacute Thyroiditis in the Time of COVID-19. Endocrinol Metab (Seoul) 2024; 39:186-187. [PMID: 38301619 PMCID: PMC10901666 DOI: 10.3803/enm.2024.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Yoo WS, Ku EJ, Lee EK, Ahn HY. Incidence of Endocrine-Related Dysfunction in Patients Treated with New Immune Checkpoint Inhibitors: A Meta-Analysis and Comprehensive Review. Endocrinol Metab (Seoul) 2023; 38:750-759. [PMID: 37956967 PMCID: PMC10764989 DOI: 10.3803/enm.2023.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGRUOUND This study investigated the incidence of endocrine immune-related adverse events (irAEs) for recently developed immune checkpoint inhibitor (ICI) drugs. METHODS We collected studies on newly developed ICI drugs using PubMed/Medline, Embase, and Cochrane Library from inception through January 31, 2023. Among ICI drugs, nivolumab, pembrolizumab, and ipilimumab were excluded from the new ICI drugs because many papers on endocrine-related side effects have already been published. RESULTS A total of 44,595 patients from 177 studies were included in this analysis. The incidence of hypothyroidism was 10.1% (95% confidence interval [CI], 8.9% to 11.4%), thyrotoxicosis was 4.6% (95% CI, 3.8% to 5.7%), hypophysitis was 0.8% (95% CI, 0.5% to 1.1%), adrenal insufficiency was 0.9% (95% CI, 0.7% to 1.1%), and hyperglycemia was 2.3% (95% CI, 1.6% to 3.4%). Hypothyroidism and thyrotoxicosis occurred most frequently with programmed cell death protein-1 (PD-1) inhibitors (13.7% and 7.5%, respectively). The rate of endocrine side effects for the combination of a programmed death-ligand 1 inhibitor (durvalumab) and cytotoxic T lymphocyte-associated antigen 4 inhibitor (tremelimumab) was higher than that of monotherapy. In a meta-analysis, the combination of tremelimumab and durvalumab had a 9- to 10-fold higher risk of pituitary and adrenal-related side effects than durvalumab alone. CONCLUSION Newly developed PD-1 inhibitors had a high incidence of thyroid-related irAEs, and combined treatment with durvalumab and tremelimumab increased the risk of pituitary- and adrenal-related irAEs. Based on these facts, it is necessary to predict the endocrine side effects corresponding to each ICI drug, diagnose and treat them appropriately, and try to reduce the morbidity and mortality of patients.
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Affiliation(s)
- Won Sang Yoo
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Eu Jeong Ku
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Lee J, Kang J, Ahn HY, Lee JK. Sex-specific risk factors associated with graves' orbitopathy in Korean patients with newly diagnosed graves' disease. Eye (Lond) 2023; 37:3382-3391. [PMID: 37041348 PMCID: PMC10630462 DOI: 10.1038/s41433-023-02513-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/07/2023] [Accepted: 03/23/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE To assess sex-specific risk factors for Graves' orbitopathy (GO) in newly diagnosed Graves' disease (GD) patients. METHODS A retrospective cohort study was conducted using the National Health Insurance Service's sample database, which consisted of 1,137,861 subjects from 2002 to 2019. The international classification of disease-10 codes was used to identify those who developed GD (E05) and GO (H062). A multivariable Cox proportional hazards model was used to estimate the effect of risk factors on GO development. RESULTS Among 2145 male and 5047 female GD patients, GO occurred in 134 men (6.2%) and 293 women (5.8%). A multivariable Cox regression model revealed that GO development was significantly associated with younger age (HR = 0.84, 95% CI = 0.73-0.98), low income (HR = 0.55, 95% CI = 0.35-0.86), and heavy drinking (HR = 1.79, 95% CI = 1.10-2.90) in men, and with younger age (HR = 0.89, 95% CI = 0.81-0.98), lower body mass index (HR = 0.55, 95% CI = 0.33-0.90), high total cholesterol (HR = 1.04, 95% CI = 1.01-1.06), hyperlipidaemia (HR = 1.37, 95% CI = 1.02-1.85), and lower statin dose (HR = 0.37, 95% CI = 0.22-0.62) in women. There was no association between smoking and GO development in both men and women. CONCLUSIONS The risk factors for GO development were sex-dependent. These results show the need for more sophisticated attention and support considering sex characteristics in GO surveillance.
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Affiliation(s)
- Jooyoung Lee
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jinmo Kang
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Jeong Kyu Lee
- Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea.
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Ahn HY, Cho SW, Lee MY, Park YJ, Koo BS, Chang HS, Yi KH. Prevalence, Treatment Status, and Comorbidities of Hyperthyroidism in Korea from 2003 to 2018: A Nationwide Population Study. Endocrinol Metab (Seoul) 2023; 38:436-444. [PMID: 37435663 PMCID: PMC10475966 DOI: 10.3803/enm.2023.1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/24/2023] [Accepted: 05/22/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGRUOUND This study aimed to investigate the changes of incidence and treatment of choice for hyperthyroidism from 2003 to 2018 and explore the treatment-related complications and concomitant comorbidities in South Korea using data from the National Health Insurance Service. METHODS This is a retrospective observational study. Hyperthyroidism was defined as a case having two or more diagnostic codes of thyrotoxicosis, with antithyroid drug intake for more than 6 months. RESULTS The average age-standardized incidence of hyperthyroidism from 2003 to 2018 was 42.23 and 105.13 per 100,000 men and women, respectively. In 2003 to 2004, hyperthyroidism was most often diagnosed in patients in their 50s, but in 2017 to 2018, people were most often diagnosed in their 60s. During the entire period, about 93.7% of hyperthyroidism patients were prescribed with antithyroid drugs, and meanwhile, the annual rates of ablation therapy decrease from 7.68% in 2008 to 4.56% in 2018. Antithyroid drug-related adverse events, mainly agranulocytosis and acute hepatitis, as well as complications of hyperthyroidism such as atrial fibrillation or flutter, osteoporosis, and fractures, occurred more often in younger patients. CONCLUSION In Korea, hyperthyroidism occurred about 2.5 times more in women than in men, and antithyroid drugs were most preferred as the first-line treatment. Compared to the general population, hyperthyroid patients may have a higher risk of atrial fibrillation or flutter, osteoporosis, and fractures at a younger age.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi Young Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Joo Park
- Department of Internal Medicine and Genomic Medicine Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Bon Seok Koo
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hang-Seok Chang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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Ahn HY, Yi KH. Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum: Revised Korean Thyroid Association Guidelines. Endocrinol Metab (Seoul) 2023:EnM.2023.1696. [PMID: 37291743 DOI: 10.3803/enm.2023.1696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023] Open
Abstract
Thyroid hormone plays a critical role in fetal growth and development, and thyroid dysfunction during pregnancy is associated with several adverse outcomes, such as miscarriage and preterm birth. In this review, we introduce and explain three major changes in the revised Korean Thyroid Association (KTA) guidelines for the diagnosis and management of thyroid disease during pregnancy: first, the normal range of thyroid-stimulating hormone (TSH) during pregnancy; second, the treatment of subclinical hypothyroidism; and third, the management of euthyroid pregnant women with positive thyroid autoantibodies. The revised KTA guidelines adopt 4.0 mIU/L as the upper limit of TSH in the first trimester. A TSH level between 4.0 and 10.0 mIU/L, combined with free thyroxine (T4) within the normal range, is defined as subclinical hypothyroidism, and a TSH level over 10 mIU/L is defined as overt hypothyroidism regardless of the free T4 level. Levothyroxine treatment is recommended when the TSH level is higher than 4 mIU/L in subclinical hypothyroidism, regardless of thyroid peroxidase antibody positivity. However, thyroid hormone therapy to prevent miscarriage is not recommended in thyroid autoantibody-positive women with normal thyroid function.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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Chung CW, Jung KY, Jung EH, Lee MJ, Park YJ, Lee JK, Ahn HY, Cho SW. Efficacy of selenium supplementation for mild-to-moderate Graves' ophthalmopathy in a selenium-sufficient area (SeGOSS trial): study protocol for a phase III, multicenter, open-label, randomized, controlled intervention trial. Trials 2023; 24:272. [PMID: 37060084 PMCID: PMC10103450 DOI: 10.1186/s13063-023-07282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/28/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND The therapeutic effect of selenium has been demonstrated in mild Graves' ophthalmopathy (GO) in a European region where selenium status is suboptimal. However, there is a lack of evidence to support selenium use in selenium-sufficient areas. The aim of this study is to evaluate the therapeutic effect of selenium in mild-to-moderate GO in selenium-sufficient South Korea. METHODS The SeGOSS trial is a multicenter, prospective, randomized, open-label trial in South Korea. Eighty-four patients aged 19 years or older with mild-to-moderate GO will be randomized to receive either vitamin B complex alone or vitamin B complex with selenium for 6 months with three monthly follow-up visits. The primary outcome is comparison of the improvement in quality of life at 6 months from baseline between the control and selenium groups. The secondary outcomes are intergroup differences in changes in quality of life at 3 months, clinical activity of GO at 3 and 6 months, thyroid autoantibody titers at 3 and 6 months, and the response rate at 3 and 6 months from baseline. Quality of life will be measured by questionnaire for patients with GO, and the clinical activity of GO will be evaluated by the clinical activity score (CAS). A positive response is defined as either changes in the CAS < 0 or the changes in the GO-QOL score ≥ 6. DISCUSSION The SeGOSS study will evaluate the therapeutic potential of selenium for mild-to-moderate GO in a selenium-sufficient area and provide support in tailoring better treatment for GO. TRIAL REGISTRATION KCT0004040. Retrospectively registered on 5 June 2019. https://cris.nih.go.kr/cris/search/detailSearch.do/14160 .
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Affiliation(s)
- Chae Won Chung
- Department of Internal Medicine, College of Medicine, Seoul National University, 101, Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Kyong Yeun Jung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Eun Hye Jung
- Department of Ophthalmology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, College of Medicine, Seoul National University, 101, Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Kyu Lee
- Department of Ophthalmology, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, College of Medicine, Chung-Ang University, 102, Heukseok-Ro, Dongjak-Gu, Seoul, 06973, Republic of Korea.
| | - Sun Wook Cho
- Department of Internal Medicine, College of Medicine, Seoul National University, 101, Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Cho SW, Kim JH, Choi HS, Ahn HY, Kim MK, Rhee EJ. Big Data Research in the Field of Endocrine Diseases Using the Korean National Health Information Database. Endocrinol Metab (Seoul) 2023; 38:10-24. [PMID: 36758542 PMCID: PMC10008661 DOI: 10.3803/enm.2023.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
The Korean National Health Information Database (NHID) contains big data combining information obtained from the National Health Insurance Service and health examinations. Data are provided in the form of a cohort, and the NHID can be used to conduct longitudinal studies and research on rare diseases. Moreover, data on the cause and date of death are provided by Statistics Korea. Research and publications based on the NHID have increased explosively in the field of endocrine disorders. However, because the data were not collected for research purposes, studies using the NHID have limitations, particularly the need for the operational definition of diseases. In this review, we describe the characteristics of the Korean NHID, operational definitions of endocrine diseases used for research, and an overview of recent studies in endocrinology using the Korean NHID.
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Affiliation(s)
- Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Eun Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Background: The most prevalent extrathyroidal manifestation of Graves' disease (GD) is Graves' ophthalmopathy (GO). However, only few methods allow for predictions of GO occurrence or progression in patients with GD. Methods: We retrospectively analyzed 1,074 patients with new-onset GD, and divided them into a derivation and a validation cohort based on the date of their GD diagnosis. We then separately analyzed clinical risk factors affecting the occurrence and progression of GO using multivariable regression analysis and created a predictive model based on the factors we identified as significant. Results: Of the 853 GD patients included in the derivation cohort, 101 (11.8%) developed GO. Those who developed GO were more likely to be smokers (25.7% vs. 8.5%, p < 0.001), were younger at the time of their GD diagnosis (35.0 years vs. 42.0 years, p < 0.001), more commonly had a family history of GD (27.7% vs. 17.2%, p = 0.015), and had higher thyrotropin-binding inhibitor immunoglobulin (TBII) levels at the time of their diagnosis (13.5 IU/L vs. 10.0 IU/L, p = 0.020) than those who did not develop GO. Of the 101 GO patients in the derivation cohort, after excluding 8 who initially had active and moderate-to-severe GO, 11 of the remaining 93 had progressed to more active or severe GO. GO patients with confirmed progression had a higher proportion of those older than 45 years (54.5% vs. 19.8%, p = 0.031), and they had a different initial clinical activity score distribution. The multivariable regression analysis identified age at GD diagnosis, sex, smoking history, family history of GD, total cholesterol level, and TBII level at the time of the diagnosis as significant risk factors of GO occurrence, and a predictive model including these risk factors was built to create a nomogram. Conclusions: The predictors of GO occurrence in patients with new-onset GD were female sex, positive smoking history, young age, family history of GD, high cholesterol level, and high TBII level. The predictive nomogram developed in this study may be useful in patient counseling and facilitating informed treatment decision-making.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-ang University College of Medicine, Seoul, Korea
| | - Jooyoung Lee
- Department of Applied Statistics, and Chung-ang University College of Medicine, Seoul, Korea
| | - Jeong Kyu Lee
- Department of Ophthalmology, Chung-ang University College of Medicine, Seoul, Korea
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Ahn HY, Choi HS, Ha S, Cho SW. Incidence of Subacute Thyroiditis During the COVID-19 Pandemic in South Korea Using the National Health Insurance Service Database. Thyroid 2022; 32:1299-1306. [PMID: 36047822 DOI: 10.1089/thy.2022.0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Subacute thyroiditis (SAT) is a thyroid disease initiated by viral infection. Whether severe acute respiratory syndrome coronavirus 2 infection can cause SAT is unclear. This study investigated changes in the nationwide incidence of SAT during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This is a retrospective, cross-sectional population-based study. Data regarding SAT and related viral diseases, including COVID-19, from 2017 to 2020 were collected from the National Health Insurance Service and Korea Disease Control and Prevention Agency databases. Results: In a total of 15,447 patients, 2484 men and 12,963 women diagnosed with SAT from 2017 to 2020 were included in this study. The incidence of SAT was significantly higher in 2020 than in 2017-2019 (8.30 vs. 7.27 per 100,000 persons, p < 0.001), while the incidence of SAT-related respiratory viral diseases, except for COVID-19, markedly decreased in 2020. The peak age of SAT incidence in 2020 was 50-59 years, and the women-to-men ratio was 5.4 (similar to that in 2017-2019). Corticosteroids were prescribed more often (72% vs. 58%, p < 0.001), and the prescription rate exceeding 1 month was significantly higher (45% vs. 40%, p < 0.01) in 2020 than in 2017-2019. Conclusions: The incidence of SAT increased in 2020 in association with COVID-19. A diagnostic approach to COVID-19 needs to be considered in patients with SAT during the COVID-19 pandemic.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Chung-Ang University Gwang-Myeong Hospital, Gwangmyeong-si, Korea
| | - Seongjun Ha
- Big Data Strategy Department, National Health Insurance Service, Wonju, Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Ku EJ, Yoo WS, Lee EK, Ahn HY, Woo SH, Hong JH, Chung HK, Park JW. Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2021; 106:3655-3667. [PMID: 34302730 DOI: 10.1210/clinem/dgab539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Indexed: 01/31/2023]
Abstract
CONTEXT Because subclinical hyperthyroidism increases the risk of osteoporosis and fractures, concerns are growing about the long-term skeletal safety of TSH suppression therapy after total thyroidectomy in patients with differentiated thyroid cancer (DTC). OBJECTIVE We aimed to determine the effect of TSH suppression therapy on bone mineral density (BMD) in DTC patients. METHODS We searched PubMed, Embase, the Cochrane library, and other sources. Eligible observational studies included DTC patients who underwent TSH suppression therapy and BMD measurement. Two independent reviewers extracted data on the studies' characteristics and outcomes and determined their risk of bias. Data were extracted from each study for postmenopausal/premenopausal women's and men's lumbar spine (LS), femoral neck (FN), and total hip (TH) BMD and summed using a random-effects meta-analysis model. The weighted mean differences with 95% CIs are expressed for the differences in outcome measurements between groups. RESULTS Seventeen studies (739 patients and 1085 controls) were included for quantitative analysis. In postmenopausal women, TSH suppression therapy showed a significant decrease in LS BMD (-0.03; -0.05, -0.02), and a similar trend was seen in TH. In premenopausal women, TSH suppression therapy significantly increased LS BMD (0.04; 0.02, 0.06) and FN BMD (0.02; 0.01, 0.04). In men, there was no significant association between TSH suppression therapy and BMD at any site compared with the controls. CONCLUSION Evidence from observational studies suggests that postmenopausal women treated with TSH suppression therapy are at risk for lower BMD. Attention should be paid to long-term skeletal safety in DTC survivors.
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Affiliation(s)
- Eu Jeong Ku
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, 28644, Republic of Korea
| | - Won Sang Yoo
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, 31116, Republic of Korea
| | - Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, 10408, Republic of Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, 06973, Republic of Korea
| | - Seung Hoon Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University, Cheonan, 31116, Republic of Korea
| | - Jun Hwa Hong
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, 35233, Republic of Korea
| | - Hyun Kyung Chung
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, 31116, Republic of Korea
| | - Jin-Woo Park
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, 28644, Republic of Korea
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Lee EK, Ahn HY, Ku EJ, Yoo WS, Lee YK, Nam KH, Chai YJ, Moon S, Jung YS. Cardiovascular Outcomes in Thyroid Cancer Patients Treated With Thyroidectomy: A Meta-analysis. J Clin Endocrinol Metab 2021; 106:3644-3654. [PMID: 34347085 DOI: 10.1210/clinem/dgab576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Thyroid dysfunction is associated with an increased risk of cardiovascular disease (CVD) in the general population; however, it remains controversial whether differentiated thyroid cancer (DTC) treatment, including thyroidectomy and thyroid-stimulating hormone suppression, further increases the risk of CVD. OBJECTIVE This study aimed to evaluate the risk of CVD in patients with DTC. METHODS We performed a review of observational studies on associations between DTC and cardiovascular outcomes, indexed in MEDLINE, Embase, and Web of Science. We excluded studies that evaluated CVD as comorbidity before DTC diagnosis and those that used active surveillance without thyroidectomy as an intervention. Risk estimates were pooled using random- and fixed-effects models when 3 or more studies reported on the outcome of interest. Echocardiographic and hemodynamic parameters were examined. RESULTS Eighteen studies were included in the quantitative analysis (193 320 cases with DTC and 225 575 healthy controls). DTC was associated with an increased risk of atrial fibrillation (pooled risk ratio [RR] = 1.55 [95% CI: 1.30-1.84]), coronary artery disease (RR = 1.10 [1.00-1.21]), cerebrovascular accidents (RR = 1.15 [1.09-1.20]), and all-cause mortality (RR = 1.95 [1.03-3.69]). DTC was associated with higher diastolic blood pressure (standardized mean difference [SMD], 0.22 [0.01-0.42]), heart rate (0.37 [0.17-0.57]), left ventricular mass index (0.66 [0.45-0.88]), and interventricular septal thickness (0.91 [0.33-1.49]) and lower early to late ventricular filling velocities (-0.42 [-0.79 to -0.05]), but not with ejection fraction. CONCLUSION Patients with DTC are at an increased risk of atrial fibrillation, CVD, increased heart rate, and left ventricular mass development.
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Affiliation(s)
- Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, 10408, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, 06973, Korea
| | - Eu Jeong Ku
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, 28644, Korea
| | - Won Sang Yoo
- Department of Internal Medicine, Dankook Univeristy College of Medicine, Cheonan, 31116, Korea
| | - Young Ki Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, 10408, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, 07061, Korea
| | - Shinje Moon
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, 07441, Korea
| | - Yuh-Seog Jung
- Center for Thyroid Cancer, National Cancer Center, Goyang, 10408, Korea
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Kim M, Cho SW, Park YJ, Ahn HY, Kim HS, Suh YJ, Choi D, Kim BK, Yang GE, Park IS, Yi KH, Jung CK, Kim BH. Clinicopathological Characteristics and Recurrence-Free Survival of Rare Variants of Papillary Thyroid Carcinomas in Korea: A Retrospective Study. Endocrinol Metab (Seoul) 2021; 36:619-627. [PMID: 34107674 PMCID: PMC8258331 DOI: 10.3803/enm.2021.974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/04/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We aimed to evaluate the clinicopathological features and biological behaviors of Korean thyroid cancer patients with rare variants of papillary thyroid carcinoma (PTC) to address the ambiguity regarding the prognostic consequences of these variants. METHODS We retrospectively reviewed the medical records of 5,496 patients who underwent thyroid surgery for PTC, between January and December 2012, in nine tertiary hospitals. Rare PTC variants included tall cell (TCV), columnar cell (CCV), diffuse sclerosing (DSV), cribriform-morular (CMV), solid (SV), hobnail, and Warthin-like variants. Recurrence-free survival (RFS) was defined as the time from the date of thyroidectomy until recurrence. RESULTS Rare variants accounted for 1.1% (n=63) of the PTC patients; with 0.9% TCV, 0.02% CCV, 0.1% DSV, 0.1% CMV, and 0.1% SV. The mean age of patients and primary tumor size were 42.1±13.1 years and 1.3±0.9 cm, respectively. Extrathyroidal extension and cervical lymph node metastasis were observed in 38 (60.3%) and 37 (58.7%) patients, respectively. Ultrasonographic findings revealed typical malignant features in most cases. During a median follow-up of 7 years, 6.3% of patients experienced a locoregional recurrence. The 5-year RFS rates were 71.4% in patients with DSV or SV, 95.9% for TCV, or CCV, and 100% for other variants. DSV emerged an independent risk factor associated with shorter RFS. CONCLUSION In this multicenter Korean cohort, rare variants accounted for 1.1% of all PTC cases, with TCV being the most frequent subtype. DSV emerged as a significant prognostic factor for RFS.
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Affiliation(s)
- Mijin Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan,
Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Hwa Young Ahn
- Division of Endocrinology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Yong Joon Suh
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang,
Korea
| | - Dughyun Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Korea
| | - Bu Kyung Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan,
Korea
| | - Go Eun Yang
- Department of Radiology, School of Medicine, Kangwon National University Hospital, Chuncheon,
Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong,
Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan,
Korea
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Chung CW, Choi HS, Kong SH, Park YJ, Park DJ, Ahn HY, Cho SW. Measurements of Bone Health after Thyroid-Stimulating Suppression Therapy in Postmenopausal Women with Differentiated Thyroid Carcinoma: Bone Mineral Density versus the Trabecular Bone Score. J Clin Med 2021; 10:jcm10091964. [PMID: 34063726 PMCID: PMC8125563 DOI: 10.3390/jcm10091964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Thyroid-stimulating hormone (TSH) suppression therapy is an important treatment modality for differentiated thyroid carcinoma (DTC), but it increases fracture risk. The aim of this study was to evaluate changes in bone mineral density (BMD) and trabecular bone score (TBS) in postmenopausal DTC patients receiving TSH suppression therapy. Methods: A total of 410 postmenopausal DTC patients who underwent thyroidectomy and had at least two dual-energy X-ray absorptiometry measurements, including a preoperative measurement, were included. Patients who had osteoporosis medication for more than 1 year were classified as ‘patients with osteoporosis’. Results: In patients without osteoporosis, the change in %BMD was similar between TSH suppression (−) and (+) groups, while the decrease in %TBS was significantly greater in the TSH suppression (+) group than that of the TSH suppression (−) group. The relative risk of vertebral fracture was decreased by TBS changes but not by BMD changes. In patients with osteoporosis, both BMD and TBS showed significant increases in the TSH suppression (−) group but not in TSH suppression (+) group. At year 4, TBS was significantly lower in the TSH suppression (+) group than that in the TSH suppression (−) group, while BMD showed no difference between groups. Conclusions: TBS may better reflect bone health than BMD in postmenopausal DTC patients with TSH suppression therapy.
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Affiliation(s)
- Chae Won Chung
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.W.C.); (Y.J.P.); (D.J.P.)
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon-si 24289, Korea;
| | - Sung Hye Kong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
- Department of Internal Medicine, Seoul National University Bundang Hospital, Kyonggi 13620, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.W.C.); (Y.J.P.); (D.J.P.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.W.C.); (Y.J.P.); (D.J.P.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul 06973, Korea;
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (C.W.C.); (Y.J.P.); (D.J.P.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
- Correspondence: ; Tel.: +82-2-2072-4761
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14
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Ahn HY, Song RY, Ahn HS, Kim HS. Expression of Estrogen and Progesterone Receptors in Papillary Thyroid Carcinoma in Korea. Cancer Res Treat 2021; 53:1204-1212. [PMID: 33592140 PMCID: PMC8524007 DOI: 10.4143/crt.2020.1201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/10/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this study was to examine the rate of expression of estrogen receptor α (ERα) and β1 (ERβ1), progesterone receptor (PR), and rate of overexpression of epidermal growth factor receptor (EGFR) in a relatively large cohort of patients with papillary thyroid carcinoma (PTC). We also aimed to examine whether each receptor influenced clinicopathological characteristics and prognosis of PTC. Materials and Methods We made a microarray of paraffin-embedded PTC surgical tissues from 436 patients. We compared the results of the immunohistochemical staining for each hormone receptor with clinicopathological characteristics. Results The positive expression rate of hormonal receptors was 40.4% for ERα, 83.7% for ERβ1, and 71.3% for PR in patients with PTC. Overexpression of EGFR was shown in 19.3% of patients with PTC. The age was lower (44.6±12.1 years vs. 47.1±12.5 years, p=0.040) and tumor smaller (0.96±0.69 cm vs. 1.13±0.82 cm, p=0.020) in the ERα positive group, which also showed higher PR positivity (80.7% vs. 65.0%, p < 0.001) and overexpression of EGFR (27.3% vs. 13.8%, p < 0.001). However, neither the positivity of hormone receptors nor overexpression of EGFR affected the recurrence of PTC. Conclusion In conclusion, most (94.6%) patients with PTC were found to exhibit positive expression for ERs or PR. We also found that neither the positive expression of hormone receptors nor overexpression of EGFR were associated with the recurrence of PTC.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ra-Yeong Song
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
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Kim JM, Park KY, Kim HR, Ahn HY, Pantoni L, Park MS, Han SH, Jung HB, Bae J. Association of Bone Mineral Density to Cerebral Small Vessel Disease Burden. Neurology 2021; 96:e1290-e1300. [PMID: 33431517 DOI: 10.1212/wnl.0000000000011526] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To test the hypothesis that bone mineral loss is mechanistically related to cerebral small vessel disease (SVD), we investigated the relationship between bone mineral density and the prevalence and intensity of SVD among patients with stroke. METHODS We analyzed data of 1,190 consecutive patients with stroke who were >50 years of age and underwent both brain MRI and dual-energy x-ray absorptiometry from the stroke registry of Chung-Ang University Hospital in Seoul, Korea. The patients were categorized into 3 groups according to their bone mineral density (normal, osteopenia, and osteoporosis). White matter hyperintensities, silent lacunes, cerebral microbleeds, and extensive perivascular space were assessed from brain MRI. Multinomial logistic regression model was used to examine the association between osteoporosis and total SVD score. We also recruited 70 patients with stroke to study serum bone turnover markers and microRNAs related to both cerebral atherosclerosis and bone metabolism to understand bone and brain interaction. RESULTS Osteoporosis was determined among 284 patients (23.9%), and 450 patients (37.8%) had osteopenia. As bone mineral density decreased, total SVD score and the incidence of every SVD phenotype increased except strictly lobar cerebral microbleeds. Multinomial logistic regression analysis showed that osteoporosis was independently associated with severe SVD burden. The levels of microRNA-378f were significantly increased among the patients with osteoporosis and maximal total SVD score and positively correlated with parathyroid hormone and osteocalcin. CONCLUSIONS These findings suggest a pathophysiologic link between bone mineral loss and hypertensive cerebral arteriolar degeneration, possibly mediated by circulating microRNA.
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Affiliation(s)
- Jeong-Min Kim
- From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea
| | - Kwang-Yeol Park
- From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea.
| | - Hye Ryoun Kim
- From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea
| | - Hwa Young Ahn
- From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea
| | - Leonardo Pantoni
- From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea
| | - Moo-Seok Park
- From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea.
| | - Su-Hyun Han
- From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea
| | - Hae-Bong Jung
- From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea
| | - Jaehan Bae
- From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea
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Ahn HY, Chae JE, Moon H, Noh J, Park YJ, Kim SG. Trends in the Diagnosis and Treatment of Patients with Medullary Thyroid Carcinoma in Korea. Endocrinol Metab (Seoul) 2020; 35:811-819. [PMID: 33212545 PMCID: PMC7803611 DOI: 10.3803/enm.2020.709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Thyroid cancer is becoming increasingly common worldwide, but little is known about the epidemiology of medullary thyroid carcinoma (MTC). This study investigated the current status of the incidence and treatment of MTC using Korean National Health Insurance Service (NHIS) data for the entire Korean population from 2004 to 2016. METHODS This study included 1,790 MTC patients identified from the NHIS database. RESULTS The age-standardized incidence rate showed a slightly decreasing or stationary trend during the period, from 0.25 per 100,000 persons in 2004 to 0.19 in 2016. The average proportion of MTC among all thyroid cancers was 0.5%. For initial surgical treatment, 65.4% of patients underwent total thyroidectomy. After surgery, external-beam radiation therapy (EBRT) was performed in 10% of patients, a proportion that increased from 6.7% in 2004 to 11.0% in 2016. Reoperations were performed in 2.7% of patients (n=49) at a median of 1.9 years of follow-up (interquartile range, 1.2 to 3.4). Since November 2015, 25 (1.4%) patients with MTC were prescribed vandetanib by December 2016. CONCLUSION The incidence of MTC decreased slightly with time, and the proportion of patients who underwent total thyroidectomy was about 65%. EBRT, reoperation, and tyrosine kinase inhibitor therapy are additional treatments after initial surgery for advanced MTC in Korea.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Eun Chae
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hyemi Moon
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Corresponding authors: Young Joo Park, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea, Tel: +82-2-2072-4183, Fax: +82-2-762-2199, E-mail:
| | - Sin Gon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Sin Gon Kim, Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea, Tel: +82-2-920-5890, Fax: +82-2-922-5974, E-mail:
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Abstract
BACKGROUND High-dose intravenous steroids are the first-line treatment for patients with moderate-to-severe and active Graves' ophthalmopathy (GO). We aimed to investigate the response rate of methylprednisolone (MPD) treatment among Korean patients with active moderate-to-severe GO and to identify predictive factors of treatment response. METHODS This is a retrospective observational study. We included 54 active moderate-to-severe GO patients treated with 4.5 g intravenous MPD over 12 weeks between November 2011 and November 2018. Response was defined as an improvement in at least two of five indicators (clinical activity score [CAS], soft-tissue involvement, exophthalmos, diplopia, and visual acuity) at immediate and 3 months after treatment completion. We examined predictive factors for response using logistic regression analysis. RESULTS Twenty-four (44.4%) and 22 (40.7%) patients showed response at immediate and 3 months after intravenous (IV) steroid treatment. Of the five ophthalmic parameters, all patients in the responsive group (100.0%) showed a decrease in CAS and 90.9% showed less soft tissue involvement after IV steroid treatment. Among variables, the sum of extraocular muscle width was positively (odds ratio [OR], 1.163; 95% confidence interval [CI], 0.973-1.389; P = 0.096) associated with treatment response. While, the OR of age was 0.918 (95% CI, 0.856-0.985; P = 0.017) and thyrotropin binding inhibitory immunoglobulin (TBII) was 0.921 (95% CI, 0.864-0.982; P = 0.012). CONCLUSION In Korean active moderate-to-severe GO patients, intravenous steroid treatment is not as effective as previously reported. Parameters associated with CAS and soft-tissue involvement were found to be influenced by IV MPD treatment. Extraocular muscle enlargement, younger age and lower TBII are predictive factors for a good steroid treatment response.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong Kyu Lee
- Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea.
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18
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Kim JH, Chae HW, Chin SO, Ku CR, Park KH, Lim DJ, Kim KJ, Lim JS, Kim G, Choi YM, Ahn SH, Jeon MJ, Hwangbo Y, Lee JH, Kim BK, Choi YJ, Lee KA, Moon SS, Ahn HY, Choi HS, Hong SM, Shin DY, Seo JA, Kim SH, Oh S, Yu SH, Kim BJ, Shin CH, Kim SW, Kim CH, Lee EJ. Diagnosis and Treatment of Growth Hormone Deficiency: A Position Statement from Korean Endocrine Society and Korean Society of Pediatric Endocrinology. Endocrinol Metab (Seoul) 2020; 35:272-287. [PMID: 32615711 PMCID: PMC7386113 DOI: 10.3803/enm.2020.35.2.272] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022] Open
Abstract
Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.
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Affiliation(s)
- Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Yonsei University College of Medicine, Seoul,
Korea
| | - Sang Ouk Chin
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Cheol Ryong Ku
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Kyeong Hye Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Dong Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Yun Mi Choi
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong,
Korea
| | - Seong Hee Ahn
- Department of Endocrinology, Inha University School of Medicine, Incheon,
Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Yul Hwangbo
- Department of Internal Medicine, National Cancer Center, Goyang,
Korea
| | - Ju Hee Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Bu Kyung Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan,
Korea
| | - Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon,
Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
Korea
| | - Seong-Su Moon
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju,
Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon,
Korea
| | - Sang Mo Hong
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong,
Korea
| | - Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Ji A Seo
- Division of Endocrinology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan,
Korea
| | - Se Hwa Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon,
Korea
| | - Seungjoon Oh
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Sung Hoon Yu
- Department of Endocrinology and Metabolism, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri,
Korea
| | - Byung Joon Kim
- Division of Endocrinology, Department of Internal Medicine, Gachon University College of Medicine, Incheon,
Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul,
Korea
| | - Sung-Woon Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon,
Korea
| | - Eun Jig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
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Yoo WS, Ahn HY, Ahn HS, Chung YJ, Kim HS, Cho BY, Seo M, Moon JH, Park YJ. Malignancy rate of Bethesda category III thyroid nodules according to ultrasound risk stratification system and cytological subtype. Medicine (Baltimore) 2020; 99:e18780. [PMID: 31914102 PMCID: PMC6959967 DOI: 10.1097/md.0000000000018780] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The risk of malignancy is considered to be 10% to 30% for cases of thyroid nodules with atypia or follicular lesion of undetermined significance (AUS/FLUS). However, only a minority of patients with AUS/FLUS undergo surgery; therefore, the risk of malignancy might be overestimated due to selection bias. To overcome this problem, we categorized cases of thyroid nodules with AUS/FLUS using the ultrasound risk stratification system (US-RSS) to calculate the malignancy rate and identify the patients most suitable for surgical treatment.In this retrospective observational study, we subcategorized 382 pathologically confirmed thyroid nodules with AUS/FLUS using current US-RSSs (American Thyroid Association, Korean-Thyroid Imaging Report and Data System, American College of Radiology-Thyroid Imaging, Reporting and Data System, European Thyroid Imaging Report and Data System) and calculated the malignancy rate. Additionally, cases of nodules with AUS/FLUS were categorized according to their cytological subtypes, and the malignancy rate was calculated.Current US-RSSs showed good or moderate agreement among them. The overall malignancy rate for thyroid nodules with AUS/FLUS was 38.7%. On categorization of the nodules with AUS/FLUS, the malignancy rates were found to be 60% to 67.5% for the high suspicion category, 32.2-36.6% for the intermediate suspicion category, and 12.4% to 16.3% for the low suspicion category. The malignancy rate for nodules with cytologic atypia was significantly higher than that for nodules with architectural atypia, especially in the intermediate suspicion category.Categorization of thyroid nodules with AUS/FLUS using current US-RSSs helps to determine the optimal course of management of patients, especially when combined with cytological subtype characterization.
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Affiliation(s)
- Won Sang Yoo
- Department of Internal Medicine, Dankook University College of Medicine
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | | | | | | | - Hee Sung Kim
- Pathology, Chung-Ang University College of Medicine
| | | | - Mirinae Seo
- Radiology
- Department of Radiology, Kyung Hee University Hospital, Seoul
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Seong JY, Ahn HY, Park Y, Shin S, Ha IH. Association Between Aerobic Exercise and Handgrip Strength in Adults: A Cross-Sectional Study Based on Data from the Korean National Health and Nutrition Examination Survey (2014-2017). J Nutr Health Aging 2020; 24:619-626. [PMID: 32510115 DOI: 10.1007/s12603-020-1372-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Handgrip strength is an easy-to-assess indicator of overall muscle strength and can be used to evaluate health status. Although previous studies have reported an increase in grip strength due to aerobic exercise, such a study has not been conducted on Korean participants. This study aimed to investigate the effects of aerobic exercise on handgrip strength and examine the association between these two variables in Korean patients with hypertension or diabetes. DESIGN Cross-sectional study. SETTING This study used data from the 6th and 7th Korean National Health and Nutrition Examination Survey (2014-2017). PARTICIPANTS A total of 19,650 individuals aged ≥19 years who had responded to questionnaires concerning aerobic exercise and handgrip strength were analyzed. MEASUREMENTS The relationship between aerobic activity and handgrip strength was examined by logistic regression analysis. RESULTS The mean age of individuals in the low muscle strength group was higher than that in the normal muscle strength group. The odds ratio for low handgrip strength was higher in individuals who did not perform aerobic exercise than in those who performed aerobic exercise. Following adjustment for covariates, the odds ratios (95% confidence intervals) for low handgrip strength were 1.415 (0.187-1.688) in the total sample, 1.799 (1.376-2.352) in patients with hypertension, and 1.811 (1.208-2.715) in patients with diabetes. CONCLUSION The results of our study indicated a strong association between aerobic exercise and handgrip strength in the Korean population.
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Affiliation(s)
- J Y Seong
- In-Hyuk Ha, Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 537 Gangnam-daero, Gangnam-gu, Seoul 06110, Republic of Korea, Tel: +82-2-2222-2740; Fax: +82-2-3218-2244, E-mail:
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Lee EK, Kim SM, Kim BH, Kim MJ, Lim DJ, Kim MH, Shin DY, Kang HC, Ahn BC, Kim SW, Ahn HY, Park YJ. Lesion-Based Evaluation Predicts Treatment Response to Lenvatinib for Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Korean Multicenter Retrospective Study. Thyroid 2019; 29:1811-1819. [PMID: 31482759 DOI: 10.1089/thy.2019.0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Lenvatinib, a tyrosine kinase inhibitor (TKI) recently approved for treating radioactive iodine-refractory differentiated thyroid cancer, has been shown to delay disease progression and provide meaningful benefit for overall survival (OS). However, there is no predictive marker for response to lenvatinib before initiating treatment. We comprehensively analyzed clinical and radiological parameters to predict response to lenvatinib using lesion-based assessments. Methods: Medical records were collected from 67 patients treated with lenvatinib in 11 referral hospitals across Korea from June 2015 to December 2017. Up to 96 measurable lesions, defined as per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, were evaluated serially until progressive disease (PD) occurred, and tumor doubling time (TDT) was calculated based on changes between historical computed tomography (CT) scans and baseline CT scans performed at treatment initiation. Results: Excluding patients with anaplastic thyroid cancer, no thyroidectomy, nontarget lesions only, or treatment periods of <1 month, 57 patients were analyzed, of whom 7 (12.2%) were TKI-naive. The median progression-free survival was 5.1 months (95% confidence interval [CI], 4.4-9.5), the median OS was 19.3 months (95% CI 12.4-not reached), the mean duration of response was 6.0 ± 4.4 months, and the objective response rate was 38%. In lesion-based assessments, 31 lesions (32.2%) with significant tumor shrinkage (complete remission or partial response) were significantly associated with shorter TDT (<12 months; p = 0.02). Patients with rapidly PD with a shorter initial TDT (<6 months) were more likely to respond to lenvatinib (p = 0.03). Patients exposed to lenvatinib at an average of ≥16 mg per day, or who were TKI-naive before treatment with lenvatinib, had a lower risk of progression; however, the risk reduction did not reach statistical significance (daily dosage p = 0.07, TKI exposure p = 0.09). Conclusions: TDT calculations at the beginning of treatment and lesion-based tumor assessment may help identify potential responders to lenvatinib therapy and predict therapeutic responses.
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Affiliation(s)
- Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Min Joo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Dong-Jun Lim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min-Hee Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong Yeob Shin
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, School Medicine, Kyungpook National University, Daegu, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Moon JH, Hyun MK, Lee JY, Shim JI, Kim TH, Choi HS, Ahn HY, Kim KW, Park DJ, Park YJ, Yi KH. Prevalence of thyroid nodules and their associated clinical parameters: a large-scale, multicenter-based health checkup study. Korean J Intern Med 2018; 33:753-762. [PMID: 28859466 PMCID: PMC6030422 DOI: 10.3904/kjim.2015.273] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/03/2016] [Accepted: 06/13/2016] [Indexed: 12/19/2022] Open
Abstract
Background/Aims We evaluated the prevalence and characteristics of thyroid nodules detected by thyroid ultrasound (US) at health checkups and the associated clinical parameters. METHODS A total of 72,319 subjects who underwent thyroid US at three health checkup centers in Korea from January 2004 to December 2010 were included in this study. The correlations between the presence of thyroid nodules and other clinical parameters were analyzed. RESULTS The prevalence of thyroid nodules and cysts was 34.2% (n = 24,757). Thyroid nodules were more prevalent in women and older age groups. Among the subjects with thyroid nodules with size information (n = 24,686), 18,833 (76.3%) had nodules measuring ≤ 1.0 cm. Women and older age groups showed higher proportion of larger nodules. Percentage of women, age, body mass index (BMI), waist circumference, body fat composition, blood pressure, and the level of fasting glucose, total cholesterol, and low density lipoprotein cholesterol were higher in the subjects with thyroid nodules compared to those without nodules. The prevalence of metabolic syndrome and overt/subclinical thyrotoxic state was higher in the subjects with thyroid nodules. In the multivariable logistic regression analysis, women, age, BMI, metabolic syndrome, and thyrotoxicosis were independently associated with the presence of thyroid nodules. Conclusions The high prevalence of thyroid nodules in people who underwent thyroid US at a health checkup suggests that increased detection of thyroid nodules resulted in an increased prevalence in the general population. However, metabolic disturbances may also have contributed to the increase in thyroid nodule prevalence in Korea.
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Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Kyung Hyun
- Department of Preventive Medicine, Dongguk University College of Korean Medicine, Gyeongju, Korea
| | - Ja Youn Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jung Im Shim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Tae Hyuk Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Kyung Won Kim
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Joo Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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Abstract
BACKGROUND To minimize potential harm from overuse of fine-needle aspiration, Thyroid Imaging Reporting and Data Systems (TIRADSs) were developed for thyroid nodule risk stratification. The purpose of this study was to perform validation of three scoring risk-stratification models for thyroid nodules using ultrasonography features, a web-based malignancy risk-stratification system, and a model developed by the Korean Society of Thyroid Radiology and the American College of Radiology. METHODS Using ultrasonography images, radiologists assessed thyroid nodules according to the following criteria: internal content, echogenicity of the solid portion, shape, margin, and calcifications. A total of 954 patients (Mage = 50.8 years; range 13-86 years) with 1112 nodules were evaluated at the authors' institute from January 2013 to December 2014. The discrimination ability of the three models was assessed by estimating the area under the receiver operating characteristic curve. Additionally, Hosmer-Lemeshow goodness-of-fit statistics (calibration ability) were used to evaluate the agreement between the observed and expected number of nodules that were benign or malignant. RESULTS Thyroid malignancy was present in 37.2% (414/1112) of nodules. According to the 14-point web-based scoring risk-stratification system, malignancy risk ranged from 4.5% to 100.0% and was positively associated with an increase in risk scores. The areas under the receiver operating characteristic curve of the validation set were 0.884 in the web-based model, 0.891 in the Korean Society of Thyroid Radiology model, and 0.875 in the American College of Radiology model. The Hosmer-Lemeshow goodness-of-fit test indicated that the web-based scoring system showed the best-calibrated result, with a p-value of 0.078. CONCLUSION The three scoring risk-stratification models using the ultrasonography features of thyroid nodules to stratify malignancy risk showed acceptable predictive accuracy and similar areas under the curve. The web-based scoring system demonstrated the strongest agreement in calibration ability analysis. The easily accessible automated web-based scoring risk-stratification system may overcome the complexity of the various Thyroid Imaging Reporting and Data System guidelines and provide simplified guidance on personalized and optimal management in real practice.
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Affiliation(s)
- Su Min Ha
- 1 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
| | - Hye Shin Ahn
- 1 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
| | - Jung Hwan Baek
- 2 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Hwa Young Ahn
- 3 Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
| | - Yun Jae Chung
- 3 Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
| | - Bo Youn Cho
- 3 Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
| | - Sung Bin Park
- 1 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
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Abstract
Graves disease is the most common cause of thyrotoxicosis. Although medical intervention with antithyroid drugs (ATDs) is commonly the first choice of treatment in Korea, the remission rate associated with this approach is not satisfactory. During ATD therapy, low or undetectable serum levels of thyroid-stimulating hormone (TSH) receptor antibodies (TRAbs) have been reported to affect the incidence of Graves disease remission. This study evaluated the correlation between serum 25-hydroxyvitamin D levels and TRAb levels, as well as the effect of 25-hydroxyvitamin D on the recurrence of Graves disease.A total of 143 patients, who were diagnosed with Graves disease and treated with ATDs, were retrospectively included in our observational study. These patients were followed for more than 1 year after ATD discontinuation. The levels of serum 25-hydroxyvitamin D and TRAb (ie, thyroid-stimulating antibody [TSAb], as detected by bioassay, and TSH-binding inhibitory immunoglobulins [TBIIs]) were measured, and a thyroid function test was performed upon ATD discontinuation. Recurrence was evaluated every 3 months, and was defined as an occurrence of overt thyrotoxicosis during the follow-up period.A total of 95 patients (66.4%) experienced recurrence with a median latency period of 182 days (ranging 28-1219 days). The serum 25-hydroxyvitamin D levels at the time of ATD discontinuation were not correlated with either TBII or TSAb. In the Cox proportional hazard regression analysis, higher free T4 levels (>1.4 ng/dL; hazard ratio [HR], 3.252; 95% confidence interval [CI], 1.022-10.347) and low levels of 25-hydroxyvitamin D (≤14.23 ng/mL) were associated with a higher probability of Graves disease recurrence (HR, 3.016; 95% CI, 1.163-7.819).Lower serum 25-hydroxyvitamin D levels were associated with a higher incidence of Graves disease recurrence. Therefore, serum 25-hydroxyvitamin D might be an independent risk factor for predicting Graves disease recurrence after ATD discontinuation.
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Abstract
BACKGROUND Vitamin D deficiency has been known to be associated with the aggressiveness and prognosis of several cancers. This study evaluated the effect of preoperative serum vitamin D levels on the aggressiveness and prognosis of papillary thyroid cancer (PTC). METHODS In total, 820 patients with PTC were enrolled. 25-hydroxyvitamin D levels were measured in blood samples before surgery. Clinical, pathologic, and recurrence data were accessed to examine the prognostic effects of vitamin D. Patients were categorized into four quartiles by preoperative serum vitamin D levels. RESULTS Of the enrolled patients, 795 (97%) had insufficient vitamin D levels (<30 ng/mL). Vitamin D levels showed positive correlations with age and body mass index (BMI), and negative correlations with serum thyrotropin levels and antithyroid peroxidase antibody titers. The association between vitamin D quartile and the risks of extrathyroidal invasion, lymph node metastasis, advanced cancer stages (III or IV), and risk of recurrence were not significant after adjusting for age, sex, BMI, preoperative ionized calcium, and parathyroid hormone. Additionally, serum vitamin D was not associated with recurrent or persistent PTC. CONCLUSION Serum vitamin D levels are not associated with either disease aggressiveness or poor outcomes among patients with PTC and vitamin D insufficiency.
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Affiliation(s)
- Hwa Young Ahn
- 1 Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
| | - Yun Jae Chung
- 1 Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
| | - Kwang-Yeol Park
- 2 Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
| | - Bo Youn Cho
- 1 Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea
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Ahn HY, Kim HH, Kim YA, Kim M, Ohn JH, Chung SS, Lee YK, Park DJ, Park KS, Moore DD, Park YJ. Thyroid Hormone Regulates the mRNA Expression of Small Heterodimer Partner through Liver Receptor Homolog-1. Endocrinol Metab (Seoul) 2015; 30:584-92. [PMID: 26485468 PMCID: PMC4722415 DOI: 10.3803/enm.2015.30.4.584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/24/2015] [Accepted: 09/24/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Expression of hepatic cholesterol 7α-hydroxylase (CYP7A1) is negatively regulated by orphan nuclear receptor small heterodimer partner (SHP). In this study, we aimed to find whether thyroid hormone regulates SHP expression by modulating the transcriptional activities of liver receptor homolog-1 (LRH-1). METHODS We injected thyroid hormone (triiodothyronine, T3) to C57BL/6J wild type. RNA was isolated from mouse liver and used for microarray analysis and quantitative real-time polymerase chain reaction (PCR). Human hepatoma cell and primary hepatocytes from mouse liver were used to confirm the effect of T3 in vitro. Promoter assay and electrophoretic mobility-shift assay (EMSA) were also performed using human hepatoma cell line. RESULTS Initial microarray results indicated that SHP expression is markedly decreased in livers of T3 treated mice. We confirmed that T3 repressed SHP expression in the liver of mice as well as in mouse primary hepatocytes and human hepatoma cells by real-time PCR analysis. LRH-1 increased the promoter activity of SHP; however, this increased activity was markedly decreased after thyroid hormone receptor β/retinoid X receptor α/T3 administration. EMSA revealed that T3 inhibits specific LRH-1 DNA binding. CONCLUSION We found that thyroid hormone regulates the expression of SHP mRNA through interference with the transcription factor, LRH-1.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hwan Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ye An Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hun Ohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Soo Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kwang Lee
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - David D Moore
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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An JH, Hwangbo Y, Ahn HY, Keam B, Lee KE, Han W, Park DJ, Park IA, Noh DY, Youn YK, Cho BY, Im SA, Park YJ. A Possible Association Between Thyroid Cancer and Breast Cancer. Thyroid 2015; 25:1330-8. [PMID: 26442580 DOI: 10.1089/thy.2014.0561] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Several lines of evidence suggest that breast cancer (BC) and thyroid cancer (TC) occur together in the same female patients more frequently than would be expected by chance. This study investigated the prevalence and clinicopathological characteristics of second primary BC in TC patients and second primary TC in BC patients. METHODS A retrospective case-controlled study was performed in 4243 patients with differentiated TC and 6833 patients with BC. Age-matched control groups without second malignancies were selected. RESULTS Of the 4243 patients with TC, 55 patients developed subsequent BC during a five-year follow-up (range 2-40 years); the standardized incidence ratio (SIR) was 2.45 [confidence interval (CI) 1.83-2.96]. Among the 6833 patients with BC, 81 patients developed subsequent TC during a 6.2-year follow-up (range 2-40 years); the SIR was 2.18 [CI 1.43-2.82]. Subsequent second BC or TC diagnosed within five years of the initial primary malignancy showed more clinical characteristics consistent with early-stage cancer than did control BC or TC patients. Notably, the expression of both the estrogen and progesterone receptors was significantly higher in the tissues of BC patients with coexisting TC compared with those with BC alone. CONCLUSIONS The overall risk of second primary TC or BC is increased in patients with prior BC or TC, respectively. The early detection of second cancer might have contributed to these findings. However, BC that coexisted with TC had a higher expression of hormone receptors, suggesting an association between the molecular pathogenesis of TC and BC.
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MESH Headings
- Adenocarcinoma, Follicular/epidemiology
- Adult
- Breast Neoplasms/epidemiology
- Breast Neoplasms/metabolism
- Carcinoma/epidemiology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Papillary
- Case-Control Studies
- Female
- Humans
- Incidence
- Middle Aged
- Neoplasms, Multiple Primary/epidemiology
- Neoplasms, Second Primary/epidemiology
- Prevalence
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/epidemiology
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Affiliation(s)
- Jee Hyun An
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
- 2 Department of Internal Medicine, Korea University College of Medicine , Seoul, Korea
| | - Yul Hwangbo
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
| | - Hwa Young Ahn
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
- 3 Department of Internal Medicine, Chung-Ang University College of Medicine , Seoul, Korea
| | - Bhumsuk Keam
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
| | - Kyu Eun Lee
- 4 Department of Surgery, Seoul National University College of Medicine , Seoul, Korea
| | - Wonshik Han
- 4 Department of Surgery, Seoul National University College of Medicine , Seoul, Korea
| | - Do Joon Park
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
| | - In Ae Park
- 5 Department of Pathology, Seoul National University College of Medicine , Seoul, Korea
| | - Dong-Young Noh
- 4 Department of Surgery, Seoul National University College of Medicine , Seoul, Korea
| | - Yeo-Kyu Youn
- 4 Department of Surgery, Seoul National University College of Medicine , Seoul, Korea
| | - Bo Youn Cho
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
- 3 Department of Internal Medicine, Chung-Ang University College of Medicine , Seoul, Korea
| | - Seock-Ah Im
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
| | - Young Joo Park
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
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Lim JA, Kim HJ, Ahn HY, Park KU, Yi KH, Park DJ, Jang HC, Park YJ. Influence of thyroid dysfunction on serum levels of angiopoietin-like protein 6. Metabolism 2015; 64:1279-83. [PMID: 26189599 DOI: 10.1016/j.metabol.2015.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 12/01/2022]
Abstract
Angiopoietin-like protein 6 (ANGPTL6) is a novel metabolic regulator that modulates energy expenditure as well as glucose and lipid metabolism. Thyroid hormone can induce metabolic changes that are similar to those induced by ANGPTL6. Herein, we investigated whether circulating ANGPTL6 levels change according to thyroid hormone status in humans. We measured the serum levels of ANGPTL6 and metabolic parameters in 150 drug-naïve subjects with overt hyperthyroid, subclinical hyperthyroid, euthyroid, subclinical hypothyroid, or overt hypothyroid status (n=30 in each group). Serum ANGPTL6 levels were significantly higher in patients with overt hypothyroidism than in the other subjects. Women had significantly higher serum levels of ANGPTL6 than men. ANGPTL6 levels correlated positively with thyroid stimulating hormone (TSH), total cholesterol, aspartate aminotransferase, and alanine aminotransferase (ALT) and negatively with serum free thyroxine (T4) level. Multiple stepwise linear regression analysis revealed that sex, TSH, free T4, and ALT were independent predictors of serum ANGPTL6 levels. In summary, serum ANGPTL6 levels increased in patients with a hypothyroid status, and both TSH and free T4 levels are associated with ANGPLT6 levels, suggesting a possible association between thyroid function and ANGPTL6 levels. Whether the upregulated ANGPTL6 level in the hypothyroid status is primarily owing to a direct association or a compensatory mechanism remains to be determined.
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Affiliation(s)
- Jung Ah Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul; Department of Internal Medicine, National Medical Center, Seoul
| | - Hyo Jeong Kim
- Department of Internal Medicine, Eulji University School of Medicine, Eulji Medical Center, Seoul
| | - Hwa Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul; Department of Internal Medicine, Chung-Ang University Hospital, Seoul
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul.
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Ahn HY, Min HS, Yeo Y, Ma SH, Hwang Y, An JH, Choi HS, Keam B, Im SA, Park DJ, Park IA, Noh DY, Youn YK, Chung JK, Cho BY, Park SK, Park YJ. Radioactive Iodine Therapy Did Not Significantly Increase the Incidence and Recurrence of Subsequent Breast Cancer. J Clin Endocrinol Metab 2015; 100:3486-93. [PMID: 26147607 DOI: 10.1210/jc.2014-2896] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Previous studies on the extent to which radioactive iodine (RAI) therapy for thyroid cancer increases the risk of subsequently developing breast cancer have given conflicting results. OBJECTIVE This study aimed to evaluate the effect of RAI treatment on breast cancer development and recurrence among female patients with primary thyroid cancer. DESIGN This was a retrospective cohort study. The risk of subsequent breast cancer associated with RAI and its dose in hazard ratios (HRs) with 95% confidential intervals (CIs) were calculated using time-dependent Cox proportional hazard models. PATIENTS A total of 6150 patients with thyroid cancer enrolled between 1973 and 2009 were followed until December 2012. Of these, 3631 (59.0%) received RAI therapy. During the follow-up period, 99 primary breast cancers were diagnosed. MAIN OUTCOME MEASURE Risk of breast cancer development according to RAI therapy and RAI dose during treatment for primary thyroid cancer. RESULTS RAI therapy did not significantly increase the incidence of subsequent breast cancer among female patients (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.22-1.06) when a 2-year latency period was accounted for. High-dose RAI (≥120 mCi) was associated with a reduced incidence of subsequent breast cancer (HR, 0.17; 95% CI, 0.05-0.62) in the cohort with a 2-year latency period. CONCLUSIONS The long-term follow-up results of this study suggest that RAI treatment for patients with thyroid cancer may not increase the risk or recurrence of breast cancer.
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Affiliation(s)
- Hwa Young Ahn
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Hye Sook Min
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Yohwan Yeo
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Seung Hyun Ma
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Yunji Hwang
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Jee Hyun An
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Hoon Sung Choi
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Bhumsuk Keam
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Seock-Ah Im
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Do Joon Park
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - In Ae Park
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Dong-Young Noh
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Yeo-Kyu Youn
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - June-Key Chung
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Bo Youn Cho
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Sue K Park
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Young Joo Park
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
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Ahn HY, Kim M, Ahn YT, Sim JH, Choi ID, Lee SH, Lee JH. The triglyceride-lowering effect of supplementation with dual probiotic strains, Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032: Reduction of fasting plasma lysophosphatidylcholines in nondiabetic and hypertriglyceridemic subjects. Nutr Metab Cardiovasc Dis 2015; 25:724-733. [PMID: 26044516 DOI: 10.1016/j.numecd.2015.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 04/30/2015] [Accepted: 05/02/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS This study evaluated the triglyceride (TG)-lowering effects of consuming dual probiotic strains of Lactobacillus curvatus (L. curvatus) HY7601 and Lactobacillus plantarum (L. plantarum) KY1032 on the fasting plasma metabolome. METHODS AND RESULTS A randomized, double-blind, placebo-controlled study was conducted on 92 participants with hypertriglyceridemia but without diabetes. Over a 12-week testing period, the probiotic group consumed 2 g of powder containing 5 × 10(9) colony-forming units (cfu) of L. curvatus HY7601 and 5 × 10(9) cfu of L. plantarum KY1032 each day, whereas the placebo group consumed the same product without probiotics. Fasting plasma metabolomes were profiled using UPLC-LTQ-Orbitrap MS. After 12 weeks of treatment, the probiotic group displayed a 20% reduction (p = 0.001) in serum TGs and 25% increases (p=0.001) in apolipoprotein A-V (apoA-V). At the 12-week follow-up assessment, the following 11 plasma metabolites were significantly reduced in the probiotic group than the placebo group: palmitoleamide, palmitic amide, oleamide, and lysophosphatidyl choline (lysoPC) containing C14:0, C16:1, C16:0, C17:0, C18:3, C18:2, C18:1, and C20:3. In the probiotic group, changes (▵) in TG were negatively correlated with ▵ apoA-V, which was positively correlated with ▵ FFA. In addition, ▵ FFA was strongly and positively correlated with ▵ lysoPCs in the probiotic group but not the placebo group. CONCLUSIONS The triglyceride-lowering effects of probiotic supplementation, partly through elevated apoA-V, in borderline to moderate hypertriglyceridemic subjects showed reductions in plasma metabolites, fatty acid primary amides and lysoPCs (NCT02215694; http://www.clinicaltrials.gov). Clinical trials: NCT02215694; http://www.clinicaltrials.gov.
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Affiliation(s)
- H Y Ahn
- Interdisciplinary Course of Science for Aging, Yonsei University, Seoul, South Korea
| | - M Kim
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, South Korea
| | - Y-T Ahn
- Korea Yakult Co., Ltd., Yongin, Gyeonggi, South Korea
| | - J-H Sim
- Korea Yakult Co., Ltd., Yongin, Gyeonggi, South Korea
| | - I-D Choi
- Korea Yakult Co., Ltd., Yongin, Gyeonggi, South Korea
| | - S-H Lee
- Department of Family Practice, National Health Insurance Corporation Ilsan Hospital, Goyang, South Korea
| | - J H Lee
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, South Korea; National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, South Korea; Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea.
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Moon MK, Jeong IK, Jung Oh T, Ahn HY, Kim HH, Park YJ, Jang HC, Park KS. Long-term oral exposure to bisphenol A induces glucose intolerance and insulin resistance. J Endocrinol 2015; 226:35-42. [PMID: 25972359 DOI: 10.1530/joe-14-0714] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 12/19/2022]
Abstract
Bisphenol A (BPA) is a widely used endocrine disruptor. Recent epidemiologic results have suggested an association between exposure to BPA and cardiovascular disease, type 2 diabetes, and obesity. We investigated the in vivo effects of long-term oral exposure to BPA on insulin resistance and glucose intolerance. In the present study, 4- to 6-week-old male mice on a high-fat diet (HFD) were treated with 50 μg/kg body weight per day of BPA orally for 12 weeks. Long-term oral exposure to BPA along with an HFD for 12 weeks induced glucose intolerance in growing male mice. Intraperitoneal glucose tolerance tests showed that the mice that received an HFD and BPA exhibited a significantly larger area under the curve than did those that received an HFD only (119.9±16.8 vs. 97.9±18.2 mM/min, P=0.027). Body weight, percentage of white adipose tissue, and percentage of body fat did not differ between the two groups of mice. However, treatment with BPA reduced Akt phosphorylation at position Thr308 and GSK3β phosphorylation at position Ser9 in skeletal muscle. BPA tended to decrease serum adiponectin levels and to increase serum interleukin 6 and tumor necrosis factor α, although these findings were not statistically significant. Treatment with BPA did not induce any detrimental changes in the islet area or morphology or the insulin content of β cells. In conclusion, long-term oral exposure to BPA induced glucose intolerance and insulin resistance in growing mice. Decreased Akt phosphorylation in skeletal muscle by way of altered serum adipocytokine levels might be one mechanism by which BPA induces glucose intolerance.
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Affiliation(s)
- Min Kyong Moon
- Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
| | - In-Kyong Jeong
- Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
| | - Tae Jung Oh
- Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
| | - Hwa Young Ahn
- Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
| | - Hwan Hee Kim
- Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
| | - Young Joo Park
- Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
| | - Hak Chul Jang
- Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
| | - Kyong Soo Park
- Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of KoreaDepartment of Internal MedicineBoramae Medical Center, Seoul 156-707, Republic of KoreaDepartment of Internal MedicineChung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 156-755, Republic of KoreaClinical Research InstituteSeoul National University Hospital, Seoul 110-74, Republic of KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
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Khang AR, Cho SW, Choi HS, Ahn HY, Yoo WS, Kim KW, Kang KW, Yi KH, Park DJ, Lee DS, Chung JK, Cho BY, Park YJ. The risk of second primary malignancy is increased in differentiated thyroid cancer patients with a cumulative (131)I dose over 37 GBq. Clin Endocrinol (Oxf) 2015; 83:117-23. [PMID: 25115234 DOI: 10.1111/cen.12581] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/14/2014] [Accepted: 08/07/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to investigate the risk factors for second primary malignancy (SPM) diagnosed after differentiated thyroid cancer (DTC). METHODS A total of 2468 DTC patients who underwent thyroidectomy were reviewed. SPM was defined as a non-thyroidal malignancy, diagnosed at least 1 year after the diagnosis of thyroid cancer. Patients were divided into five groups according to cumulative (131)I dose: very high-activity (≥ 37.0 GBq), high-activity (22.3-36.9 GBq), intermediate-activity (5.56-22.2 GBq), low-activity (1.1-5.55 GBq) and no RAI. RESULTS Among the 2468 patients, 61 (2.5%) had SPMs during 7.0 (1.0-33.0) years of median follow-up. Age above 40 years, male sex and very high-activity RAI were independent risk factors for the development of SPM. SPM-related mortality was highest in the very high-activity group, while DTC-related mortality was highest in the high-activity group. The overall mortality both from SPM and DTC was highest in the high-activity group. CONCLUSION A cumulative (131)I dose <37.0 GBq did not increase the risk of SPM. A cumulative (131) I dose ≥ 37.0 GBq increased the risk of SPM and SPM-related mortality and decreased the DTC-specific mortality, resulting in a similar all-cause mortality compared with the low-activity RAI group. Using repeated high-dose RAI for treating RAI-responsive but persistent DTC patients needs careful consideration of the individual benefits from RAI vs the risk of developing SPM.
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Affiliation(s)
- Ah Reum Khang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Won Sang Yoo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Dankook University Hospital, Cheonan-si, Korea
| | - Kyung Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Soon Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Youn Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Ahn HY, Kim MS, Kim MJ, Cho SY, Kim YA, Lee GH, Lee BC, Park YJ, Yi KH. Loss of ERβ expression in papillary thyroid carcinoma is associated with recurrence in young female. Clin Endocrinol (Oxf) 2015; 82:300-6. [PMID: 24801822 DOI: 10.1111/cen.12486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 02/19/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We investigated the expression of oestrogen receptors (ERs) in papillary thyroid cancers (PTCs) and evaluated their prognostic role. METHODS We enrolled 81 female patients who underwent thyroid surgery and had a confirmed diagnosis of PTC between 01 January 1995 and 31 December 1996. Data on clinicopathologic parameters were obtained from patients' medical records. Tissue paraffin blocks of these 81 patients were collected for immunohistochemistry for ERα and ERβ. RESULTS ERα expression was observed in only eight patients (9·9%). In contrast, ERβ expression was positive in 36 (44·4%) patients. Total thyroidectomy (84·4% vs 61·1%, P = 0·017) and cervical lymph node metastasis (62·2% vs 22·2%, P = 0·000) were more frequent in the ERβ-negative group than in the ERβ-positive group. Among younger female patients (<45 years), the ERβ-negative group showed a tendency towards more frequent recurrent or persistent disease than the ERβ-positive group (42·3% vs 13·6%, P = 0·029). In contrast, the ERα-positive group showed more recurrent or persistent disease than the ERα-negative group in older female patients (100% vs 24·1%, P = 0·024). In multivariate analysis, ERβ negativity, extrathyroidal invasion and radioactive iodine treatment were risk factors for recurrence in young female patients. CONCLUSION Loss of ERβ expression was associated with recurrence in young female PTC patients. This finding suggests that oestrogen might play a protective role in the progression of PTC via ERβ, especially in young female patients.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea
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Choi H, Lim JA, Ahn HY, Cho SW, Lee KE, Kim KW, Yi KH, Sung MW, Youn YK, Chung JK, Park YJ, Park DJ, Cho BY. Secular trends in the prognostic factors for papillary thyroid cancer. Eur J Endocrinol 2014; 171:667-75. [PMID: 25163726 DOI: 10.1530/eje-14-0225] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE With the recent increasing rates of screening for thyroid cancer, the cancers now tend to be smaller and less aggressive than those that are diagnosed when presented with symptoms, suggesting changes in the clinical validity of conventional prognostic factors for outcomes. We performed the retrospective study to identify the secular trends in the prognostic factors of thyroid cancer. METHODS We used medical records of 3147 patients diagnosed with papillary thyroid cancer (PTC) at the Seoul National University Hospital Thyroid Cancer Clinic between 1962 and 2009. RESULTS During the median 5.1-year follow-up, the overall recurrence rate was 13.3%, and male sex, tumor size, lymph node (LN) involvement, and extrathyroidal extension (ETE) were the significant prognostic factors for recurrence. Thyroid cancer-specific mortality was 1.4%, and the associated prognostic factors were older age, male sex, and LN involvement. For tumor recurrence, the hazard ratio (HR) for male sex decreased from 2.809 (95% CI, 1.497-5.269) in the pre-1989 period to 1.142 (95% CI, 0.736-1.772) in the post-1999 period. The pathologic characteristics, such as tumor size, LN involvement, and ETE, showed similar or increasing HRs over the time periods. For cancer-specific mortality, the HR for male sex decreased from 6.460 (95% CI, 1.714-24.348) in the pre-1990 period to 0.781 (95% CI, 0.083-7.379) in the post-1999 period. CONCLUSION The risk for poor outcomes in PTC associated with male sex decreased over time; in contrast, the risk associated with pathologic characteristics remained the same or increased over time. These trends might be associated with recent changes in the characteristics of patients with thyroid cancer.
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Affiliation(s)
- Hoonsung Choi
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Jung Ah Lim
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Hwa Young Ahn
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Sun Wook Cho
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Ka Hee Yi
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Myung-Whun Sung
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - June-Key Chung
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Do Joon Park
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
| | - Bo Youn Cho
- Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea
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Jung YY, Yoo JH, Park ES, Kim MK, Lee TJ, Cho BY, Chung YJ, Kang KH, Ahn HY, Kim HS. Clinicopathologic correlations of the BRAFV600E mutation, BRAF V600E immunohistochemistry, and BRAF RNA in situ hybridization in papillary thyroid carcinoma. Pathol Res Pract 2014; 211:162-70. [PMID: 25468810 DOI: 10.1016/j.prp.2014.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND The BRAF(V600E) mutation is the most common genetic alteration in papillary thyroid carcinoma (PTC). The aim of this study is to analyze the clinicopathologic correlations of the BRAF(V600E) mutation, BRAF V600E immunohistochemistry (IHC) and BRAF RNA in situ hybridization (ISH) in PTC. METHODS This study included 467 patients with PTC who underwent surgical resection. We studied the BRAF(V600E) mutation using real-time PCR and BRAF V600E and BRAF RNA ISH using tissue microarray (TMA). RESULTS The frequencies of a positive BRAF(V600E) mutation by real-time PCR, positive BRAF V600E IHC, and high BRAF RNA ISH were 84%, 86%, and 70%, respectively, in PTC. Conventional PTC had higher positive rates in all three tests than other histologic types. The BRAF(V600E) mutation, BRAF V600E IHC, low ΔCt, and high BRAF RNA ISH were significantly associated with lymph node metastasis. The BRAF(V600E) mutation was significantly associated with positive immunostaining for BRAF V600E mutant protein (P<0.001) overall, with high BRAF RNA ISH only in the follicular variant (P=0.035). No significant correlation was noted between BRAF V600E IHC and BRAF RNA ISH. The sensitivity of BRAF V600E IHC for the BRAF(V600E) mutation was 95%, and the specificity was 61% overall, 96% and 54% in the conventional type, and 85% and 70% in the follicular variant. CONCLUSIONS Our results showed that positive BRAF V600E IHC significantly correlated with the BRAF(V600E) mutation. This suggests its clinical utility as a screening tool for the BRAF(V600E) mutation. In addition, a high BRAF RNA ISH score could be a candidate marker of aggressive behavior in BRAF(V600E) mutation-positive cases of PTC.
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Affiliation(s)
- Yoon Yang Jung
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Hyung Yoo
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Eon Sub Park
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Mi Kyung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Tae Jin Lee
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Bo Youn Cho
- Department of Internal Medicine, Division of Endocrinology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea; Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Yun Jae Chung
- Department of Internal Medicine, Division of Endocrinology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea; Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung Ho Kang
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea; Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Division of Endocrinology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea; Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea; Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
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Cho SW, Kim YA, Sun HJ, Ahn HY, Lee EK, Yi KH, Oh BC, Park DJ, Cho BY, Park YJ. Therapeutic potential of Dickkopf-1 in wild-type BRAF papillary thyroid cancer via regulation of β-catenin/E-cadherin signaling. J Clin Endocrinol Metab 2014; 99:E1641-9. [PMID: 24848709 DOI: 10.1210/jc.2013-4467] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aberrant activation of the Wnt/β-catenin pathway is a common pathogenesis of various human cancers. We investigated the role of the Wnt inhibitor, Dkk-1, in papillary thyroid cancer (PTC). METHODS Immunohistochemical β-catenin staining was performed in tissue microarray containing 148 PTCs and five normal thyroid tissues. In vivo effects of Dkk-1 were explored using ectopic tumors with BHP10-3SC cells. RESULTS In 27 PTC patients, 60% of patients showed β-catenin up-regulation and Dkk-1 down-regulation in tumor vs normal tissues. Tissue microarray analysis showed that 14 of 148 PTC samples exhibited cytoplasmic-dominant β-catenin expression compared to membranous-dominant expression in normal tissues. Aberrant β-catenin expression was significantly correlated with higher rates of the loss of membranous E-cadherin expression and poor disease-free survival than that in the normal membranous expression group over a median follow-up period of 14 years. Implantation of Dkk-1-overexpressing BHP10-3SC cells revealed delayed tumor growth, resulting from the rescue of membranous β-catenin and E-cadherin expressions. Furthermore, tissue microarray analysis demonstrated that BRAF(WT) patients had higher rates of aberrant expressions of β-catenin and E-cadherin than BRAF(V600E) patients. Indeed, the inhibitory effects of Dkk-1 on cell survival were more sensitive in BRAF(WT) (BHP10-3SC and TPC-1) than in BRAF(V600E) (SNU-790 and BCPAP) cells. Overexpression of BRAF(V600E) in normal thyroid epithelial (H tori) cells also reduced the effects of Dkk-1 on cell survival. CONCLUSION A subset of PTC patients showed aberrant expression of β-catenin/E-cadherin signaling and poor disease-free survival. Dkk-1 might have a therapeutic role, particularly in BRAF(WT) patients.
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Affiliation(s)
- Sun Wook Cho
- Department of Internal Medicine (S.W.C., H.Y.A., D.J.P., B.Y.C., Y.J.P.), Seoul National University College of Medicine, Seoul 110-744, Korea; Department of Internal Medicine (S.W.C., H.J.S.), National Medical Center, Seoul 110-799, Korea; Departments of Pathology (Y.A.K.) and Internal Medicine (K.H.Y.), Seoul National University Boramae Medical Center, Seoul 156-707, Korea; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Seoul 156-755, Korea; Lee Gil Ya Cancer and Diabetes Institute (B-C.O.), Gachon University Graduate School of Medicine, Incheon 405-760, Korea; and Center for Thyroid Cancer (E.K.L.), National Cancer Center, Gyeonggi-do 410-769, Korea
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Ahn HY, Chung YJ. Letter: the biochemical prognostic factors of subclinical hypothyroidism (endocrinol metab 2014;29:154-62, myung won lee et Al.). Endocrinol Metab (Seoul) 2014; 29:400-1. [PMID: 25309801 PMCID: PMC4192810 DOI: 10.3803/enm.2014.29.3.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yun Jae Chung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Yoon JW, Kang SM, Vassy JL, Shin H, Lee YH, Ahn HY, Choi SH, Park KS, Jang HC, Lim S. Efficacy and safety of ginsam, a vinegar extract from Panax ginseng, in type 2 diabetic patients: Results of a double-blind, placebo-controlled study. J Diabetes Investig 2014; 3:309-17. [PMID: 24843582 PMCID: PMC4014955 DOI: 10.1111/j.2040-1124.2011.00185.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims/Introduction: The efficacy, dose–response relationship and safety of ginsam, a vinegar extract from Panax ginseng, were evaluated in an 8‐week, double‐blind, randomized, placebo‐controlled study in drug‐naïve patients with type 2 diabetes. Materials and Methods: A total of 72 diabetic patients were randomized to receive 1500, 2000 or 3000 mg of ginsam, or placebo daily for 8 weeks (n = 18 in each group). The primary end‐point was the changes from the baseline HbA1c level. The secondary end‐points were the changes of fasting and postprandial 2‐h glucose concentration, and the proportion of patients achieving a reduction in HbA1c >0.5%. Results: In the intention‐to‐treat analysis, ginsam treatment reduced HbA1c level significantly: −0.56 ± 0.25% in the 1500 mg group, −0.31 ± 0.12% in the 2000 mg group, and −0.29 ± 0.11% in the 3000 mg group (all P < 0.05), with a significant difference between the 1500 mg ginsam and the placebo group (−0.02 ± 0.12%, P = 0.021). The changes in fasting glucose concentration followed the same pattern: −21.40, −14.27 and −6.76 mg/dL for 1500, 2000, and 3000 mg, respectively, vs −2.25 mg/dL for the placebo. The percentage of patients whose HbA1c level decreased by >0.5% differed significantly between the placebo group (11.1%) and the 1500 mg (27.8%) and 2000 mg (27.8%) groups. No severe adverse events were observed in any group. Conclusions: An 8‐week treatment with ginsam, a vinegar extract from P. ginseng, moderately improved HbA1c level and was well tolerated in type 2 diabetic patients with inadequate glycemic control. This trial was registered with ClinicalTrial.Gov (no. NCT01008163). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00185.x, 2011)
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Affiliation(s)
- Ji Won Yoon
- Internal Medicine, Seoul National University College of Medicine ; Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul
| | - Seon Mee Kang
- Internal Medicine, Seoul National University College of Medicine ; Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jason L Vassy
- General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Hayley Shin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yun Hee Lee
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hwa Young Ahn
- Internal Medicine, Seoul National University College of Medicine ; Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Hee Choi
- Internal Medicine, Seoul National University College of Medicine ; Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyong Soo Park
- Internal Medicine, Seoul National University College of Medicine
| | - Hak Chul Jang
- Internal Medicine, Seoul National University College of Medicine ; Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo Lim
- Internal Medicine, Seoul National University College of Medicine ; Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Ahn HY, Chung YJ, Kim BS, Kang KH, Seok JW, Kim HS, Park SJ, Cho BY. Clinical significance of the BRAFV600E mutation in multifocal papillary thyroid carcinoma in Korea. Surgery 2014; 155:689-95. [DOI: 10.1016/j.surg.2013.12.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 12/19/2013] [Indexed: 12/29/2022]
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Ock S, Ahn J, Lee SH, Kang H, Offermanns S, Ahn HY, Jo YS, Shong M, Cho BY, Jo D, Abel ED, Lee TJ, Park WJ, Lee IK, Kim J. IGF-1 receptor deficiency in thyrocytes impairs thyroid hormone secretion and completely inhibits TSH-stimulated goiter. FASEB J 2013; 27:4899-908. [PMID: 23982142 DOI: 10.1096/fj.13-231381] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although thyroid-stimulating hormone (TSH) is known to be a major regulator of thyroid hormone biosynthesis and thyroid growth, insulin-like growth factor 1 (IGF-1) is required for mediating thyrocyte growth in concert with TSH in vitro. We generated mice with thyrocyte-selective ablation of IGF-1 receptor (TIGF1RKO) to explore the role of IGF-1 receptor signaling on thyroid function and growth. In 5-wk-old TIGF1RKO mice, serum thyroxine (T4) concentrations were decreased by 30% in concert with a 43% down-regulation of the monocarboxylate transporter 8 (MCT8), which is involved in T4 secretion. Despite a 3.5-fold increase in circulating concentrations of TSH, thyroid architecture and size were normal. Furthermore, thyrocyte area was increased by 40% in WT thyroids after 10 d TSH injection, but this effect was absent in TSH-injected TIGF1RKO mice. WT mice treated with methimazole and sodium perchlorate for 2 or 6 wk exhibited pronounced goiter development (2.0 and 5.4-fold, respectively), but in TIGF1RKO mice, goiter development was completely abrogated. These data reveal an essential role for IGF-1 receptor signaling in the regulation of thyroid function and TSH-stimulated goitrogenesis.
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Affiliation(s)
- Sangmi Ock
- 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University, 224-1 Heuk Seok-dong, Dongjak-ku Seoul 156-755, Korea.
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Kim TH, Kim KW, Ahn HY, Choi HS, Won H, Choi Y, Cho SW, Moon JH, Yi KH, Park DJ, Park KS, Jang HC, Kim SY, Park YJ. Effect of seasonal changes on the transition between subclinical hypothyroid and euthyroid status. J Clin Endocrinol Metab 2013; 98:3420-9. [PMID: 23771919 DOI: 10.1210/jc.2013-1607] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The widespread use of thyroid tests in asymptomatic individuals identifies many patients with transient subclinical hypothyroidism. OBJECTIVE Our objective was to determine the effect of seasonal change on serum TSH levels and the transition between subclinical hypothyroid and euthyroid status. DESIGN, SETTING, AND SUBJECTS This was a retrospective longitudinal study of 1751 subclinical hypothyroid and 28 096 euthyroid subjects aged over 18 years who underwent serial thyroid function tests at a health screening center between October 2003 and May 2011. MAIN OUTCOME MEASURES Age-adjusted geometric mean values of the TSH level by month were calculated using linear mixed models. Adjusted odds ratios of test season and multiple baseline clinical factors were determined using generalized estimating equations. RESULTS During a median 36 months of follow-up, 57.9% of subclinical hypothyroid subjects reverted to euthyroidism, and 4.3% of euthyroid subjects developed subclinical hypothyroidism. The monthly distribution of follow-up TSH levels indicated a biphasic pattern, ie, an increase during the winter-spring season and a decrease during the summer-fall season, with a maximal TSH difference of 0.69 mIU/L in subclinical hypothyroid and 0.30 mIU/L in euthyroid subjects. Normalization of subclinical hypothyroidism was increased 1.4-fold in follow-up tests during the summer-fall follow-up, whereas subclinical hypothyroidism increased 1.4-fold in euthyroid subjects during the winter-spring follow-up. CONCLUSIONS The season in which thyroid testing was performed was independently related to the transition between subclinical hypothyroid and euthyroid status. Seasonal variations in TSH concentration should be considered before deciding on treatment of subclinical hypothyroidism, particularly in the areas with a wide annual temperature range.
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Affiliation(s)
- Tae Hyuk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-744, Korea
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Cho BY, Choi HS, Park YJ, Lim JA, Ahn HY, Lee EK, Kim KW, Yi KH, Chung JK, Youn YK, Cho NH, Park DJ, Koh CS. Changes in the clinicopathological characteristics and outcomes of thyroid cancer in Korea over the past four decades. Thyroid 2013; 23:797-804. [PMID: 23427907 PMCID: PMC3704118 DOI: 10.1089/thy.2012.0329] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyroid cancer has increased globally, with a prominent increase in small, papillary thyroid cancers (PTC). The Korean population has a high iodine intake, high prevalence of BRAF V600E mutations, and family histories of thyroid cancer. We examined the clinicopathological characteristics and outcomes of thyroid cancers in Korean patients over four decades. METHODS The medical records of 4500 thyroid cancer patients, between 1962 and 2009 at a single center, including 3147 PTC patients, were reviewed. RESULTS The mean age of the patients was 46.8±13.2 years; women accounted for 82.9% of the patients, and the median follow-up duration was 4.8 years (mean 7.0±5.8 years, range 1-43 years). The number of patients visiting the clinic increased from 411 during 1962-1990 to 2900 during 2000-2009. Age at diagnosis increased from 39.6±12.9 to 48.6±12.4 years. The male to female ratio increased from 1:6 to 1:4.5. The proportion of small (<1 cm) tumors increased from 6.1% to 43.1%, and the proportion of cancers with lymph node (LN) involvement or extrathyroidal extension (ETE) decreased from 76.4% to 44.4% and from 65.5% to 54.8% respectively. Although there were decreases in the proportion of LN involvement and ETE, these decreasing rates were not proportional to the expected rates based on the decreased proportion of large tumors. The overall recurrence and mortality rates were 13.3% and 1.4%. The five-year recurrence rate significantly decreased (from 11% to 5.9%), and the five-year mortality also improved (from 1.5% to 0.2%). CONCLUSIONS The incidence of thyroid cancer has rapidly increased, with a decrease in tumors of large size, LN involvement, and ETE, although the decreasing rates of LN involvement and ETE were not as prominent as decreasing rates of large size tumors. The mortality and recurrence rates have also decreased. Future long-term follow-up of patients diagnosed in the most recent decade is needed to confirm the prognostic characteristics of Korean PTC patients.
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Affiliation(s)
- Bo Youn Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Roh E, Hong ES, Ahn HY, Park SY, Yoon HI, Park KS, Park YJ. A case of mediastinal ectopic thyroid presenting with a paratracheal mass. Korean J Intern Med 2013; 28:361-4. [PMID: 23682232 PMCID: PMC3654136 DOI: 10.3904/kjim.2013.28.3.361] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/06/2011] [Accepted: 02/14/2012] [Indexed: 12/31/2022] Open
Abstract
Mediastinal ectopic thyroid is a very rare condition, with few reported cases in the literature and no reported cases in Korea. This report describes an asymptomatic 65-year-old man with a right paratracheal mass compressing the superior vena. Additionally, the epidemiology, clinical manifestation, diagnosis, and management of mediastinal ectopic thyroids are discussed. A mediastinal ectopic thyroid should be considered in the differential diagnosis of all mediastinal masses. Surgical excision is recommended for both the diagnosis and treatment of this condition, because of its potential for malignancy and compression of mediastinal structures. This case demonstrates the clinical importance of mediastinal etopic thyroid.
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Affiliation(s)
- Eun Roh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Shil Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So-Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Il Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Hwang IC, Kim KK, Ahn HY, Suh HS, Oh SW. Effect of the G-protein β3 subunit 825T allele on the change of body adiposity in obese female. Diabetes Obes Metab 2013; 15:284-6. [PMID: 23061407 DOI: 10.1111/dom.12023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 09/22/2012] [Accepted: 10/10/2012] [Indexed: 11/27/2022]
Abstract
No clinical studies on the lipolytic effect of guanine nucleotide-binding protein β3 subunit gene (GNB3) 825T polymorphism have been performed. This study was a subinvestigation of a 12-week randomized controlled trial (NCT01184560) for the additive effect of orlistat on sibutramine treatment. The analysis involved 101 obese females aged 18-49 years, genotyped at the GNB3 825 locus. To exclude any influence from potential confounders, we used an analysis of covariance model. After the intervention, fat mass proportion in total weight loss was significantly lower in subjects with a T allele than in those without a T allele (p = 0.034). GNB3 825T allele was associated with blunted fat mass reduction in obese females.
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Affiliation(s)
- I C Hwang
- Department of Family Medicine, Gachon University Gil Hospital, Incheon, South Korea
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Cho SW, Lee EJ, Kim H, Kim SH, Ahn HY, Kim YA, Yi KH, Park DJ, Shin CS, Ahn SH, Cho BY, Park YJ. Dickkopf-1 inhibits thyroid cancer cell survival and migration through regulation of β-catenin/E-cadherin signaling. Mol Cell Endocrinol 2013; 366:90-8. [PMID: 23261982 DOI: 10.1016/j.mce.2012.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 11/21/2012] [Accepted: 12/10/2012] [Indexed: 01/15/2023]
Abstract
Wnt/β-catenin signaling plays a role in tumorigenesis of human papillary thyroid cancer (PTC). Dickkopf-1 (Dkk-1) is an inhibitor of Wnt/β-catenin signaling. We investigated the therapeutic potential of Dkk-1 in human PTC cell lines, SNU-790, B-CPAP, and BHP10-3. Dkk-1 reversed the aberrant expression of β-catenin from nucleus to membrane and inhibited basal levels of TCF/LEF-dependent transcriptional activities. Furthermore, Dkk-1 inhibited cell viability in a dose-dependent manner and adenoviral transduction of constitutively active β-catenin blocked these effects, thus suggesting that the Dkk-1 anti-tumoral effect is mediated by Wnt/β-catenin signaling. Bromodeoxyuridine assay showed minimal effects of Dkk-1 on cell proliferation. Flow cytometric analysis with Annexin V staining showed marked induction of cell apoptosis by Dkk-1 treatment. Dkk-1 also restored the loss of membranous E-cadherin expression with consequent inhibition of cell migration and invasion. In conclusion, Dkk-1 inhibited the survival and migration of human PTC cells by regulating Wnt/β-catenin signaling and E-cadherin expression.
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Affiliation(s)
- Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lee Y, Park YJ, Ahn HY, Lim JA, Park KU, Choi SH, Park DJ, Oh BC, Jang HC, Yi KH. Plasma FGF21 levels are increased in patients with hypothyroidism independently of lipid profile. Endocr J 2013; 60:977-83. [PMID: 23759753 DOI: 10.1507/endocrj.ej12-0427] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thyroid hormone is a potent regulator of metabolic and energy homeostasis implicated in various metabolic diseases. Fibroblast growth factor 21(FGF21) is a systemic metabolic regulator known to modulate various biological functions similar to the actions of thyroid hormone. We investigated the differences in plasma FGF21 concentrations in patients with varying thyroid function. Ninety drug-naïve subjects who underwent thyroid evaluation at Seoul National University Bundang Hospital were enrolled and classified into euthyroid, subclinical hypothyroid, and overtly hypothyroid groups. Biochemical markers and plasma FGF21 levels were measured and analyzed. The mean age of the subjects was 42.6 ± 9.1 years. The mean body mass index (BMI), waist circumference, and fasting glucose concentrations were similar between groups. Overtly hypothyroid subjects exhibited significantly higher concentrations of total cholesterol, triglyceride, and LDL-cholesterol than the other groups (p<0.01). Mean plasma FGF21 concentrations in euthyroid, subclinical hypothyroid and overtly hypothyroid groups were 43.2 ± 39.2 pg/mL, 63.6 ± 73.6 pg/mL, and 101.5 ± 74.9 pg/mL, respectively (p<0.01 between groups). Plasma FGF21 concentrations remained significantly higher in overtly hypothyroid subjects after adjusting for serum triglyceride concentrations (p<0.005). Multivariate analysis revealed a significant positive linear relationship between serum TSH concentrations and plasma FGF21 concentrations (β = 0.192, p = 0.002) and a significant negative linear relationship between free T4 and plasma FGF21 concentrations (β = -0.382, p = 0.037) after adjusting for gender, BMI and serum concentrations of triglycerides and glucose. Plasma FGF21 levels were significantly increased in patients with hypothyroidism independently of BMI, or lipid or glucose metabolism.
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Affiliation(s)
- Yenna Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abstract
AIMS The aim of this study was to investigate whether increased apolipoprotein B/apolipoprotein A-I ratio is associated with Type 2 diabetes mellitus independent of other risk factors for Type 2 diabetes. METHODS A total of 70,063 subjects (41,391 men and 28,672 women; mean age 41.5 years) who visited the Health Screening Center at Kangbuk Samsung Hospital for a routine medical check-up between January 2009 and December 2009 were enrolled in this study. RESULTS The mean apolipoprotein B/apolipoprotein A-I ratio in the study subjects was 0.66 ± 0.18. The prevalence of Type 2 diabetes increased across the apolipoprotein B/apolipoprotein A-I ratio quartiles (1.0%, 1.6%, 2.9%, and 4.8% for the 1st through 4th quartiles, respectively, P < 0.001) and homeostasis model assessment-insulin resistance (HOMA2-IR) also showed an increasing tendency by quartile (P < 0.001). The apolipoprotein B/apolipoprotein A-I ratio was correlated with age, adiposity, blood pressure, HOMA2-IR value, fasting glucose levels, and other inflammatory marker, including high-sensitivity C-reactive protein, and lipoprotein (a) levels (all P < 0.001). In a multiple logistic regression model, the highest apolipoprotein B/apolipoprotein A-I ratio quartile was associated with Type 2 diabetes, even after controlling for other risk factors for diabetes, such as age, gender, BMI, systolic blood pressure, HOMA2-IR values, high-sensitivity C-reactive protein levels, family history of diabetes, presence of metabolic syndrome, and conventional lipid parameters (odds ratio 1.31; 95% confidence interval 1.17-1.46, P < 0.001). CONCLUSIONS The apolipoprotein B/apolipoprotein A-I ratio was found to be associated with Type 2 diabetes independent of other risk factors for diabetes and conventional lipid parameters.
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Affiliation(s)
- Y C Hwang
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Korea
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Kim WJ, Park CY, Park SE, Rhee EJ, Lee WY, Oh KW, Park SW, Kim SW, Park HS, Kim YJ, Song SJ, Ahn HY. Serum 1,5-anhydroglucitol is associated with diabetic retinopathy in Type 2 diabetes. Diabet Med 2012; 29:1184-90. [PMID: 22332964 DOI: 10.1111/j.1464-5491.2012.03613.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To determine whether there is a relationship between 1,5-anhydroglucitol (1,5-AG), a marker of postprandial hyperglycaemia and glycaemic variability, and the presence of diabetic retinopathy and albuminuria in patients with Type 2 diabetes. METHODS Five hundred and sixty-seven patients with Type 2 diabetes (serum creatinine < 133 μmol/l), who were enrolled in the Seoul Metro-City Diabetes Prevention Program (SMC-DPP), were cross-sectionally assessed by multivariate logistic regression analysis. RESULTS After controlling for age, sex, binary HbA(1c) levels, duration of diabetes, triglyceride, systolic blood pressure, smoking status, history of hypertension and dyslipidaemia, and the use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker medication, the odds ratios (95% CI) of diabetic retinopathy were 2.86 (1.12-7.25) for the first (lowest) quartile of 1,5-anhydroglucitol, 2.87 (1.25-6.61) for the second quartile and 0.88 (0.35-2.22) for the third quartile compared with the fourth quartile (P for trend = 0.010). Conversely, the associations between 1,5-anhydroglucitol and clinical albuminuria were non-significant after adjustment. Subjects with low 1,5-anhydroglucitol (< 10.0 μg/ml) were more likely to experience diabetic retinopathy than those with high 1,5-anhydroglucitol (≥ 10.0 μg/ml) under moderate glucose control (HbA(1c) < 8%, 64 mmol/mol) and there were no significant differences in the prevalence of diabetic retinopathy between the subgroup with HbA(1c) < 8% (64 mmol/mol) and low 1,5-anhydroglucitol and the subgroup with HbA(1c) ≥ 8% (64 mmol/mol). CONCLUSIONS 1,5-Anhydroglucitol levels show close associations with diabetic retinopathy, especially among patients under moderate glucose control, but not with albuminuria. These results suggest that 1,5-anhydroglucitol might be a complementary marker for targeting higher risk group.
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Affiliation(s)
- W J Kim
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lim S, An JH, Shin H, Khang AR, Lee Y, Ahn HY, Yoon JW, Kang SM, Choi SH, Cho YM, Park KS, Jang HC. Factors predicting therapeutic efficacy of combination treatment with sitagliptin and metformin in type 2 diabetic patients: the COSMETIC study. Clin Endocrinol (Oxf) 2012; 77:215-23. [PMID: 21955147 DOI: 10.1111/j.1365-2265.2011.04240.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We assessed the predictive parameters for therapeutic efficacy of initial combination therapy with sitagliptin and metformin in drug-naïve type 2 diabetic patients. DeSIGN, PATIENTS, AND MEASUREMENTS: In this 52-week treatment study, 150 patients (mean age, 54·9 ± 12·5 years) with type 2 diabetes and HbA1c of 7·0-10% were treated with sitagliptin 100 mg once and metformin 500 mg twice daily. To assess the predictive parameters for therapeutic efficacy, a multivariate regression analysis was performed with baseline fasting glucose, insulin, C-peptide, and glucagon levels, homoeostasis model assessment-insulin resistance (HOMA-IR) and β-cell function (HOMA-B), insulinogenic index (IGI, defined as 30-0 min insulin/30-0 min glucose), and area under the curve for glucose, insulin, and C-peptide obtained after 75-g oral glucose tolerance test. RESULTS After 52 weeks, mean HbA1c levels and fasting and postload 2-h glucose were significantly decreased from 8·7 ± 1·4% to 7·2 ± 1·3%, 9·2 ± 3·0 to 7·2 ± 1·8 mm, and 17·5 ± 5·1 to 10·9 ± 3·6 mm, respectively (P < 0·01). HOMA-B and IGI increased significantly from 50·3 ± 33·5 to 75·1 ± 32·8 and from 11·3 ± 1·3 to 35·0 ± 6·3 at 52 weeks, respectively (P < 0·01). Multivariate regression analysis indicated that the reduction in HbA1c was significantly associated with high baseline HbA1c, low IGI, and short duration of diabetes after adjusting for age, sex, body mass index, blood pressure, triglycerides, creatinine, high-sensitivity CRP, glucagon, C-peptide, HOMA-B, and HOMA-IR. No severe adverse events were observed. CONCLUSION These results suggest that drug-naïve type 2 diabetic patients with low β-cell function would benefit the most from early initial combination therapy of sitagliptin and metformin.
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Affiliation(s)
- Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Park YJ, Ahn HY, Choi HS, Kim KW, Park DJ, Cho BY. The long-term outcomes of the second generation of familial nonmedullary thyroid carcinoma are more aggressive than sporadic cases. Thyroid 2012; 22:356-62. [PMID: 22280228 PMCID: PMC3315159 DOI: 10.1089/thy.2011.0163] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Familial nonmedullary thyroid carcinoma (FNMTC) is frequently detected, but the prevalence or the aggressiveness of FNMTC is still unclear. We aimed to investigate the prevalence, clinical characteristics, and prognosis of FNMTC. METHODS This study included 3056 nonmedullary thyroid carcinoma (NMTC) patients who were pathologically confirmed to exhibit differentiated thyroid carcinoma from January 1962 through March 2010. The duration of follow-up was 6.2±6.2 years. RESULTS The prevalence of FNMTC was 9.6%; 37.9% of the FNMTC patients exhibited a parent-offspring relationship, and 62.1% exhibited a sibling relationship. FNMTC was smaller in tumor size (1.2±0.9 vs. 1.4±1.1 cm) and more multifocal (33.6% vs. 27.0%) than sporadic cases. FNMTC presented higher recurrence rates (29.5% vs. 19.8%) and shorter recurrence-free survival than sporadic NMTC (p=0.046). When we compared sporadic NMTC with parent-offspring or sibling FNMTC separately, parent-offspring FNMTC was more multifocal (39.3% vs. 27.0%), while sibling FNMTC was more prevalent in female patients (89.6% vs. 82.5%) and presented smaller tumors (1.2±0.8 vs. 1.4±1.1 cm) than sporadic NMTC. The recurrence rate was higher than that of sporadic NMTC in parent-offspring FNMTC (35.6% vs. 19.8%) but not in sibling FNMTC. Among the 123 parent-offspring FNMTC cases, the second generation exhibited an earlier age at the diagnosis (38±11 vs. 57±11 years), more extrathyroidal invasion (57.8% vs. 29.4%), a higher recurrence rate (50.0% vs. 19.0%), and shorter recurrence-free survival (p=0.015) than the first generation. CONCLUSION FNMTC was found to have a very high prevalence in our population. Parent-offspring FNMTC demonstrated higher recurrence than sporadic NMTC; specifically, the second generation of parent-offspring FNMTC cases exhibited more aggressive clinical characteristics than the first generation.
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Affiliation(s)
- Young Joo Park
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Internal Medicine, Bundang Hospital, Seoul National University, Seongam, Republic of Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Internal Medicine, Bundang Hospital, Seoul National University, Seongam, Republic of Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Kyung Won Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Internal Medicine, University Healthcare System, Seoul National University, Seoul, Republic of Korea
| | - Do Joon Park
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Bo Youn Cho
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Internal Medicine, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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