With the generalized use of highly sensitive thyroid stimulating hormone (TSH) and free thyroid hormone assays, most thyroid function tests (TFTs) are straightforward to interpret and confirm the clinical impressions of thyroid diseases. However, in some patients, TFT results can be perplexing because the clinical picture is not compatible with the tests or because TSH and free T4 are discordant with each other. Optimizing the interpretation of TFTs requires a complete knowledge of thyroid hormone homeostasis, an understanding of the range of tests available to the clinician, and the ability to interpret biochemical abnormalities in the context of the patient's clinical thyroid status. The common etiologic factors causing puzzling TFT results include intercurrent illness (sick euthyroid syndrome), drugs, alteration in normal physiology (pregnancy), hypothalamic-pituitary diseases, rare genetic disorders, and assay interference. Sick euthyroid syndrome is the most common cause of TFT abnormalities encountered in the hospital. In hypothalamicpituitary diseases, TSH levels are unreliable. Therefore, it is not uncommon to see marginally high TSH levels in central hypothyroidism. Drugs may be the culprit of TFT abnormalities through various mechanisms. Patients with inappropriate TSH levels need a differential diagnosis between TSH-secreting pituitary adenoma and resistance to thyroid hormone. Sellar magnetic resonance imaging, serum a-subunit levels, serum sex hormone-binding globulin levels, a thyrotropin-releasing hormone stimulation test, trial of somatostatin analogues, and TR-ss sequencing are helpful for the diagnosis, but it may be challenging. TFTs should be interpreted based on the clinical context of the patient, not just the numbers and reference ranges of the tests, to avoid various pitfalls of TFTs and unnecessary costly evaluations and therapies.
Eun, Jung Nam
Choi, Yoo Duk
Lee, Jeong Ho
Jeong, Yun Ah
Yoon, Jee Hee
Kim, Hee Kyung
Kang, Ho-Cheol
Hypocalcemia is relatively uncommon paraneoplastic syndrome. Only one case of hypocalcemia has been reported in a patient with chondrosarcoma. We herein report a case of a 32-year-old woman with metastatic chondrosarcoma with tetany. Her imaging findings revealed multiple calcific metastatic lesions in the lungs, pancreas, left atrium, and pulmonary vein. A laboratory examination showed hypocalcemia with no evidence of any other disease that could induce hypocalcemia. On the basis of the laboratory and clinical findings, we concluded the etiology of her severe hypocalcemia to be excessive calcium consumption by the tumor itself.
Kim, Hee Kyung
Yoon, Jee Hee
Kim, Soo Jeong
Cho, Jin Seong
Kweon, Sun-Seog
Kang, Ho-Cheol
Objectives Higher thyroid-stimulating hormone (TSH) levels are associated with differentiated thyroid cancers (DTC). To validate this association, we compared TSH levels obtained from euthyroid patients with DTC with TSH levels from controls in the general population. Design and patients The case group included 1759 patients with DTC, who underwent thyroid surgery at Chonnam National University Hwasun Hospital. The control group (n = 1548), who had participated in the Thyroid Disease Prevalence Study were used as a healthy control group. The subjects were divided into four groups of similar size according to their TSH levels, with the first quartile used as a reference group. Results The mean TSH level of the case group was significantly higher than the mean TSH level of the control group (1.95 +/- 0.9 mIU/l vs 1.62 +/- 0.8 mIU/l, P < 0.001), and was associated with DTC risk. Multiple logistic regression, after controlling for age, gender and the presence of a family history of thyroid cancer, showed that the odds ratios and 95% confidence intervals for the second, third and fourth quartiles of TSH levels were 1.27 (1.03-1.57), 1.55 (1.25-1.92) and 2.21 (1.78-2.74) respectively. No significant differences were observed in mean TSH levels in patients with different tumour stages and tumour sizes. Conclusion Having a high TSH level within the normal range is an independent risk factor for DTC, and may contribute to the initiation of thyroid carcinogenesis. TSH levels in patients with thyroid nodules may be used as diagnostic adjuncts for the identification of high-risk patients, who require further investigation and/or surgical intervention.
Pyrrolidine dithiocarbamate (PDTC), an antioxidant with a metal-chelating activity, has been used widely to inhibit the expression of inflammatory genes in vitro and in vivo. This study investigated whether PDTC has an antimicrobial activity against various bacteria. The antibacterial activity of PDTC and other compounds was evaluated in vitro by the broth microdilution method against Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Staphylococcus aureus, and Escherichia coli. Bacterial growth was inhibited by PDTC, where a wide range of sensitivity was demonstrated among the tested bacteria. The antibacterial activity of PDTC was reduced by the addition of copper chloride; in contrast, it was enhanced considerably by zinc chloride. Two different zinc chelators, Ca-saturated EDTA (Ca-EDTA) and N,N,N',N'-tetrakis (2-pyridylmethyl) ethylenediamine, blocked the antibacterial activity of PDTC, whereas Zn-EDTA failed to reduce the activity of PDTC. These results demonstrate for the first time that PDTC possesses an antibacterial activity, for which zinc is required, and suggest that PDTC, possessing a dual anti-inflammatory and antibacterial activity, may be considered for topical use for inflammatory diseases of bacterial origin.
Kim, Hee Kyung
Kim, Sung Sun
Oak, Chan Young
Kim, Soo Jeong
Yoon, Jee Hee
Kang, Ho-Cheol
Cases of metastases to the thyroid gland seem to be increasing in recent years. The clinical and ultrasonographic findings of diffuse metastases have been sparsely reported. Thirteen cases of diffuse metastases to the thyroid gland were documented by thyroid ultrasonography-guided fine needle aspiration cytology between 2004 and 2013. We retrospectively reviewed the patients with diffuse thyroid metastases. The most common primary site was the lung (n=3D9), followed by unknown origin cancers (n=3D2), cholangiocarcinoma (n=3D1), and penile cancer (n=3D1). Eleven patients were incidentally found to have thyroid metastases via surveillance or staging FDG-PET. Other 2 patients were diagnosed during work-up for hypothyroidism and palpable cervical lymph nodes. On ultrasonography, the echogenicity of the enlarged thyroid gland was heterogeneously hypoechoic or isoechoic, and reticular pattern internal hypoechoic lines were observed without increased vascularity found by power Doppler ultrasonography (3 right lobe, 2 left lobe, and 8 both lobes). In the 8 patients who had involvement of both lobes, 3 had hypothyroidism. In conclusion, ultrasonographic finding of diffuse metastasis is a diffusely enlarged heterogeneous thyroid with reticular pattern internal hypoechoic lines. Thyroid function testing should be performed in all patients with diffuse thyroid metastases, especially those with bilateral lobe involvement. =20
Kim, Hee Kyung
Lee, Ji Shin
Park, Min Ho
Cho, Jin Seong
Yoon, Jee Hee
Kim, Soo Jeong
Kang, Ho-Cheol
INTRODUCTION: Several studies have reported a high frequency of papillary thyroid cancer (PTC) in patients with acromegaly. The aim of this study was to determine the prevalence and predictors of thyroid cancer in patients with acromegaly and to investigate the frequency of the BRAFV600E mutation in PTC patients with and without acromegaly.; MATERIALS AND METHODS: We conducted a retrospective study of 60 patients with acromegaly. Thyroid ultrasonography (US) and US-guided fine needle aspiration were performed on nodules with sonographic features of malignancy. We selected 16 patients with non-acromegalic PTC as a control group. The BRAFV600E mutation was analyzed in paraffin-embedded surgical specimens of PTC by real-time polymerase chain reaction, and tumor specimens from patients with PTC were stained immunohistochemically with an antibody against insulin-like growth factor-1 receptor beta (IGF-1Rbeta).; RESULTS: Thyroid cancer was found in 15 (25.0%) patients. No differences in age, sex, initial growth hormone (GH) and IGF-1 percentage of the upper limit of normal values or treatment modalities were observed between patients with and without PTC. Acromegaly was active in 12 of 15 patients at the time of PTC diagnosis; uncontrolled acromegaly had a significantly higher frequency in the PTC group (60%) than in the non-PTC group (28.9%) (p=E2=80=8A=3D=E2=80=8A0.030). The BRAFV600E mutation was present in only 9.1% (1/11) of PTC patients with acromegaly, although 62.5% (10/16) of control patients with PTC had the mutation (p=E2=80=8A=3D=E2=80=8A0.007). IGF-1Rbeta immunostaining showed moderate-to-strong staining in all malignant PTC cells in patients with and without acromegaly. Significantly less staining for IGF-1Rbeta was observed in normal adjacent thyroid tissues of PTC patients with acromegaly compared with those without (p=E2=80=8A=3D=E2=80=8A0.014).; CONCLUSION: The prevalence of PTC in acromegalic patients was high (25%). An uncontrolled hyperactive GH-IGF-1 axis may play a dominant role in the development of PTC rather than the BRAFV600E mutation in patients with acromegaly.=20
Kim, Sung-wan
Shin, Il-seon
Kim, Jae-min
Kang, Ho-cheol
Mun, Ji-ung
Yang, Su-jin
Yoon, Jin-sang
Gastroparesis is a condition of abnormal gastric motility characterized by delayed gastric emptying without evidence of mechanical outlet obstruction. The authors describe complete remission of recurrent postprandial discomfort, nausea, and vomiting within 1 week of starting mirtazapine in a gastroparetic patient who had failed to respond, in 7 months, to conventional prokinetics (erythromycin, metoclopramide, domperidone, perphenazine, itopride, bethanechol, and/or tegaserod) and pyloric injection of botulinum toxin. This is the first report to show that mirtazapine may be an effective alternative when gastroparesis is refractory to conventional measures.
Disclosed is a patient bed. The patient bed is Provided with legs erected from respective corners and a Mattress mounted on the upper surfaces thereof, and includes An excretory hole formed through a central portion of the mattress; stiffening members fixed to the legs; a case, having an opened upper end, fixedly installed on the stiffening members, and provided with a rail installed in a longitudinal direction on an inner bottom surface of the case; horizontal transfer main body installed in the case such that it is horizontally moved along the rail by driving of a horizontal transfer driving unit; a bedpan and a closed box respectively installed in front of and in the rear of the horizontal transfer main body such that they are vertically moved by driving of front and rear vertical transfer driving units; and a controller for controlling the horizontal transfer driving unit and the front and rear vertical transfer driving units.
Sim, Dea Seon
Kim, Young-Wun
Joeng, Noh-Hee
Kang, Ho-Cheol
The use of lubricants has grown more widespread with industrial development. Lubricants usually contain additives with heavy metals such as zinc and molybdenum, increasing the emission of heavy metal contamination of soil and ocean. This study synthesised antiwear additives without heavy metal components in a simple and efficient manner by using alkane diacid derivatives produced from biomass and dithiophosphate instead of petroleum-based compounds. A four-ball wear test was performed to examine tribological performance in relation to changes in the alkyl chain length of the diacid and dithiophosphate of the synthesised antiwear additive, and the results were compared with the performance of zinc dialkyl-dithiophosphorus (ZDDP), an antiwear additive that contains heavy metals. The tribological performance of the antiwear additives produced from synthesised dialkyl carboxylic acid derivatives was analysed based on the measurements of wear scar diameter. The wear scar diameter was 0.48mm for the synthesised antiwear additive, whereas the ZDDP at a concentration of 0.05% gave a diameter of 0.82mm. In the case of the synthesised antiwear additive, tribological performance did not improve for concentrations higher than 0.05%. An analysis of the carbon chain length of the dialkyl dithiophospate and dicarboxylic acid showed that the wear scar diameter was 0.72mm when the alkyl chain length of R-1 was 4. This diameter dropped below 0.48mm when the alkyl chain length was greater than 8. When the number of carbons of dicarboxylic acid moiety was increased from 4 to 11, the antiwear performance improved slightly, with the wear scar diameter decreasing from 0.52 to 0.48mm.
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