The fundamental study and its clinical application of the thyroid autotransplantation for the patients with permanent postoperative hypothyroidism.
Grant-in-Aid for Scientific Research (C).
|Research Institution||Nippon Medical School|
長浜 充二 日本医大, 医学部, 助手 (30241102)
SHIMIZU Kazuo Nippon Medical School Department of Surgery II Professor, 医学部, 教授 (20133449)
KITAGAWA Wataru Nippon Medical School Department of Surgery II Clinical instructor, 医学部, 助手 (80297895)
北村 裕 日本医科大学, 医学部, 助手 (90297896)
TANAKA Shigeo Nippon Medical School Department of Surgery II Professor, 医学部, 教授 (70089720)
AKASU Haruki Nippon Medical School Department of Surgery II Professor, 医学部, 助手 (30297866)
|Project Fiscal Year
1997 – 2000
Completed(Fiscal Year 2000)
|Budget Amount *help
¥2,600,000 (Direct Cost : ¥2,600,000)
Fiscal Year 2000 : ¥100,000 (Direct Cost : ¥100,000)
Fiscal Year 1999 : ¥200,000 (Direct Cost : ¥200,000)
Fiscal Year 1998 : ¥100,000 (Direct Cost : ¥100,000)
Fiscal Year 1997 : ¥2,200,000 (Direct Cost : ¥2,200,000)
|Keywords||cryopreservation / autotransplantation / postoperative hypothyroidism / Graves' disease / バセドウ病術後 / 甲状腺機能低下症 / 凍結保存甲状腺 / 自家移植 / 永続的甲状腺機能低下症 / バセドウ病 / 外科治療 / 連結保存|
Background Some patients with Graves' disease require life-long levo-thyroxime (l-T4) replacement therapy due to irreversible postoperative hypothyroidism despite the choice of surgical therapy in order to discontinue talking anti-thyroid drug. The aims of this study are to entrust the production of thyroid hormone to the autotransplanted thyroid tissue that had been cryopreserved since initial thyroid surgery, and to release these patients from taking lifelong l-T4 administration.
Methods At the time of subtotal thyroidectomy for Graves' disease, approximately 5 g of surgical specimen was cut into small pieces (less than 1 mm^3) and placed at 4℃ for one hour and at -80℃ for overnight in order and cryopreserved at -196℃ until used for autotransplantation. Four patients underwent autotransplantation of cryopreserved thyroid tissues under local anesthesia for the treatment of postoperative hypothyroidism with obtaining sufficient informed consent. Since these patients required 100〜
150μg/day of l-T4 at the postoperative point of 1.8, 3.4, 3.5 and 2.8 years respectively, 2.5 to 5.0 g of cryopreserved thyroid tissues were autotransplanted into forearm muscle to each patient.
Findings Three patients could discontinue l-T4 administration and clinical symptoms of hypothyroidism disappeared with improvement of serum TSH level until 6 to 12 weeks after transplantation. Pathological and immunohistochemical examination demonstrated well-preserved thyroid structure and thyroglobulin-positive follicular cells and colloids suggesting functional ability of transplants. ^<123>I scintiscanning examined in case 1 and 2 also indicated accumulation of radioactive iodine at the transplantation sites. One patient required l-T4 again because of recurrent hypothyroidism despite having discontinued l-T4 administration for one year.
Interpretation The occupation of the first patient is a school teacher and always has an opportunity to transfer. The second patient has two small babies and a disable husband. Because of the personal circumstances, they were anxious to whether they have to keep going hospital periodically and to take life-long l-T4. Despite the choice of surgical treatment to discontinue medication, those four patients presented here had to reversibly take l-T4. Despite a few remaining uncertainties to reach the final goal, autotransplantation of the cryopreserved thyroid tissue will be one of the useful methods which the patient can choose as one of the therapeutic procedures for treatment of permanent postoperative hypothyroidism in patient with Graves' disease in future. Less
Research Output (14results)