Ho Sang Shon

Free T4 is negatively correlated with body mass index in euthyroid women

Background/Aims Overt thyroid dysfunction is well known to affect weight. However, the influence of normal-range changes in thyroid status on body mass index (BMI) is unclear. We sought to evaluate thyroid function (free T4, TSH) and its possible relationship with BMI and lipid profiles in euthyroid subjects. Methods A total of 1572 euthyroid women (mean age 46.2 years) who visited Daegu Catholic University Medical Centre for primary health screening participated in this cross-sectional study. Women who were not euthyroid and women who took thyroid medication were excluded. TSH, free T4, and lipid profile [total-cholesterol, triglyceride (TG), HDL-C, LDL-C] were evaluated. Results Obese euthyroid women had lower free T4 levels than did lean euthyroid women. After adjustment for age and smoking, free T4, but not TSH, was significantly negatively correlated with BMI. After adjustment for age, smoking, and BMI, free T4 was negatively correlated with TG to a significant degree. Conclusions We demonstrated a negative correlation between free T4 within the normal range and BMI in euthyroid subjects. These findings suggest that low free T4 is associated with obesity in euthyroid subjects.

A Case of McCune-Albright Syndrome with Associated Multiple Endocrinopathies

McCune-Albright syndrome (MAS) is a rare disorder that develops from an activating mutation in the Gs gene. It is characterized by an association with Polyostotic fibrous dysplasia, and precocious puberty, Caf-au-lait pigmentation, and other endocrinopathies that result from the hyperactivity of a variety of endocrine glands. Recently we encountered a patient with MAS with fibrous dysplasia, skin pigmentation, acromegaly, hyperprolactinemia and a thyroid nodule. A 23-year-old male presented for an evaluation of a change in his facial structures. Fibrous dysplasia was diagnosed by a bone biopsy and radiographic studies. The GH level increased paradoxically after an oral glucose load. The plasma prolactin, IGF-1 and alkaline phosphatase were high. Thyroid ultrasonography revealed multiple nodules. The brain MRI demonstrated a mass in the left pituitary gland. Genetic analysis identified a change from Arg (CGT) at codon 201 to Cys (TGT).

Ultrasonographic Characteristics of the Follicular Variant Papillary Thyroid Cancer According to the Tumor Size

Follicular variant papillary thyroid cancer (FVPTC) is the second most common subtype after conventional PTC. We compared ultrasonographic (US) features of FVPTC to those of conventional PTC according to tumor size. We reviewed US findings, pathologic reports, and medical charts of 249 PTC patients with surgically proven disease (83 FVPTCs, 166 conventional PTCs) at our institution from January 2007 to December 2012. FVPTCs were divided into PTC-like and follicular neoplasm (FN)-like based on sonographic characteristics. PTC-like features were defined as having at least one malignant feature (taller-than-wide shape, infiltrative margin, marked hypoechogenicity, and micro-calcifications), whereas FN-like cancers showed oval solid features without malignant features. FVPTCs showed a higher rate of FN-like features than conventional PTCs. Of 166 conventional PTCs, 13 (7.8%) had FN-like features and 153 (92.2%) had PTC-like features, whereas of the 83 FVPTCs, 31 (37.3%) had FN-like features and 52 (62.7%) had PTC-like features. Macro-FVPTCs showed a higher rate of FN-like features than micro-FVPTCs (P < 0.001). Of 21 macro-FVPTCs, 18 (85.7%) had FN-like features and 3 (14.3%) had PTC-like features, whereas of the 62 micro-FVPTCs, 13 (21%) had FN-like features and 49 (79%) had PTC-like features. There were no differences in multifocality, extrathyroidal invasion, and lymph node metastasis between PTC-like FVPTCs and FN-like FVPTCs. FVPTCs showed fewer sonographic malignant features than conventional PTCs. In particular, FVPTCs larger than 1 cm had a more frequent benign sonographic appearance. Therefore, if fine-needle aspiration result is suspicious for PTC in a nodule larger than 1 cm with no suspicious US features, the possibility of FVPTC might be considered.

Radiofrequency Ablation for the Papillary Thyroid Micro-carcinoma in the HighriskSurgical Patient

Percutaneous ultrasound-guided Radiofrequencyablation (RFA) is a minimally invasive treatment that has been widely used as an alternative to surgery in the care of patients with malignant tumors of the liver, renal cell carcinoma, and other tumors. Recently, RFA is an alternative treatment modality for benign thyroid nodules instead of surgery, mainly for the cosmetic reasons, and limited cases of local recurrences or focal distant metastases of differentiated thyroid cancer in the high-risk reoperative condition or for the palliative purpose. However, RFA for the initial treatment of the DTC is rare. We report a case of RFA for the papillary thyroid microcarcinomain the high-risk surgical patient. A 49-years-old woman with congestive heart failure due to severe mitral valve regurgitation, chronic kidney disease, and type 2 diabetes was incidentally diagnosed with papillary microcarcinoma without metastasis. She underwent RFA. During 5-year follow-up, there is no recurrence of the findings.

Primary Mucosa-Associated Lymphoid Tissue Lymphoma of Thyroid with the Serial Ultrasound Findings.

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) of the thyroid gland is uncommon. Even though its natural history is not well defined, it is known to be indolent course. We present a case of primary MALT thyroid lymphoma with the serial sonographic findings in the patient presenting as the focal nodule. A 45-year-old woman visited our hospital for neck examination. Initially, fine-needle aspiration cytology in the focal hypoechoic lesion in the left thyroid lobe on ultrasound sonography was performed and consistent with Hashimotos thyroiditis. However, the results of serial ultrasounds and core-needle biopsy revealed an extranodal marginal zone lymphoma of MALT on 4-year follow-up. Patients with a focal hypoechoic nodule with linear echogenic strands and segmental pattern in the background of Hashimotos thyroiditis on ultrasonography should undergo careful surveillance for malignancy. Serial sonographic features in this case are meaningful in the understanding of the natural history of the extranodal marginal zone lymphoma of MALT of the thyroid.

Delay of insulin initiation in patients with type 2 diabetes mellitus inadequately controlled with oral hypoglycemic agents (analysis of patient- and physician-related factors): A prospective observational DIPP-FACTOR study in Korea

To assess the time to initiation of insulin therapy, and concurrently investigate both patient‐ and physician‐related factors associated with delaying insulin therapy in Korean patients with type 2 diabetes uncontrolled by oral hypoglycemic agents (OHAs).