, Hee Jin Kim, Yeon Ah Sung, Nan Ho Kyung Thyroid nodule is a common clinical problem and it is important to distinguish benign from malignant nodule. Although features found on history taking, physical examnation and imaging studies help the diagnosis, fine needle aspiration(FNA) has been accepted as an accurate and reliable diagnostic procedure of thyroid nodule. This study was aimed to assess the values of FNA and needle biopsy in the diagnosis of thyroid nodules.
We reviewed the medical records of the 405 patients who underwent FNA and needle biopsy for the diagnosis of thyroid nodule form September 1993 to July 1996.
The 414 fine needle aspiration cytologic specimens were obtained from 405 patients(male : 26, female : 379). 390 cases(94.2%) were adequate for cytologic diagnosis. And the diagnosis showed benign in 357(91.5%), malignancy in 20(5.1%) and suspicious malignancy in 13(3.3%). Among the 357 benign cases, 104 cases were benign cysts, 163 cases were adenomatous goiter and 45 cases were follicular adenoma. 46 patients underwent thyroidectomy after FNA and 21 patients(45.7%) were diagnosed as having carcinoma. The sensitivity and specificity of FNA in diagnosing malignancy were 65% and 82%, respectively, with an accuracy of 74%. Of 46 patients, needle biopsy was done in 41. The sensitivity and specificity of the needle biopsy were 79% and 73%, respectively. And the accuracy was 76%. Hoarseness was developed in one patient after FNA and needle biopsy, and small amount of hemoptysis was developed in another patient after FNA.
Although it had been expected that needle biopsy may increase the diagnostic accuracy, our study didn't show the superiority of needle biopsy as compared with FNA. FNA has limitations in suspicious and nondiagnostic results but it is a safe, simple, reliable and cost-effective means of evaluating thyroid nodules. It is the preferred initial diagnostic method in all patients with thyroid nodule.
, Nan Ho Kyung The purpose of this study is to investigate the clinical efficacy and stabilityof human insulin therapy compared with conventional animal insulin therapy in respect ofadverse reactions, glycemic control, insulin requirement and subjective satisfaction.
To investigate the clinical efficacy and stability of human insulin therapy, weconducted this study in 55 university hospitals and goneral hospitals in Korea nationwide,for a period of 32 months from January 4, 1990 through December 31, 1992. The study wasset out to replace conventional animal insulin with human insulin(HumulinR) and observedadverse reactions, changes in blood glucose levels, HbA1C, insulin requirement and subjectivesatisfaction after replacement.
Results are given as fo11ows.
1) Blood glucose level, HbAlc, and insulin requirement were significantly decreased afterreplacement animal insulin with human insulin(p<0.05).
2) As for adverse reactions, hypoglycemia was observed more frequently and the incidenceof chills and local allergic reaction at the site of insulin injection were decreased after replacement animal insulin with human insulin.
3) As for subjective satisfaction of the patients, number of patients with subjective satisfactionwere significantly increased after replacement animal insulin with human insulin(p<0.O5).
These results suggest that human insulin is preferable to animal insulins interms of glycemic control, insulin requirement and subjecive clinical response.
, Nan Ho Kyung Congenital hypothyroidism result in permanent changes of skeletal system and intellectual development.
We treated a 37-year old man with congenital hypothyroidism due to thyroid hypoplasia. He was presented with mental retardation, dwarfism, skeletal abnormalities including hip dislocation and megacolion. He has never been diagnosed or treated.
Thyroid function test revealed decreased serum T3 and T4. increased TSH and decreased I-131 uptake. Technetium-99m-pertechnate thyroid scan diclosed no functioning thyroid tissue, but normal serum thyroglobulin suggesting thyroid hypoplasia rather than athyrosis. X-ray filims of skull, hands, pelvis and knee revealed still present epiphysis, unerupted teeth, dislocated hip. A CT scan of abdomen revealed enlarged colon and tectum.
Neonatal screening program of congenital hypothyroidism will be needed in Korea.
, Eun Mi Song, Doo Hyun Beak, Hyun Jung Oh, Hyun Kyung Kim, Min Young Choi, Kyung Joo Kwon, Hye Won Kang, Seo Woo Kim, Unjin Shim, Yeon Ah Sung, Young Sun Hong Propylthiouracil(PTU) is a commonly used antithyroid drug in the management of hyperthyroidism. However, it is associated with a variety of side effects. Antineutrophil cytoplasmic antibody( ANCA)-positive vasculitis is an extremely rare side effect of PTU. We report a case of a patient with diffuse pulmonary hemorrhage while being treated with PTU. A 28-year-old woman was admitted due to fever and abdominal pain. She was diagnosed as Graves' disease 4 years before the admission, and was taking PTU intermittently. Thyroid storm was suspected and we treated her with PTU, hydrocortisone, lugol solution and propranolol. However, coughing was aggravated, with chest X-ray and computed tomography revealing diffuse alveolar hemorrhage. Perinuclear-ANCA was positive. After discontinuation of PTU, all symptoms resolved. In conclusion, ANCA-positive diffuse alveolar hemorrhage is a rare but a potential side-effect of PTU. Therefore, early awareness of this complication is important.
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