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°©»ó¼±¾Ï ȯÀÚ¿¡ ´ëÇÑ Àå±â ÃßÀû ½Ã °¡Àå Áß¿äÇÑ ÃàÀº ¹Ù·Î °©»ó¼±È£¸£¸óÀÇ Ã³¹æÀÌ´Ù. °©»ó¼±¾ÏÀ¸·Î Áø´Ü¹Þ¾Æ ¼ö¼úÀ» ¹ÞÀº ȯÀڵ鿡¼­ ÀûÀýÇÑ °©»ó¼±±â´ÉÀ» À¯ÁöÇÏ´Â °ÍÀº È£¸£¸ó ±ÕÇüÀ» ¸ÂÃß±â À§ÇÑ ¸ñÀû»Ó ¾Æ´Ï¶ó Àç¹ß ¹æÁö¸¦ À§Çؼ­µµ Áß¿äÇÏ´Ù3,4. ƯÈ÷ Àç¹ß ¹æÁö¸¦ À§Çؼ­´Â Á¤»ó °©»ó¼±±â´ÉÀ» À¯ÁöÇÏ´Â Á¤µµ°¡ ¾Æ´Ñ, °©»ó¼±ÀÚ±ØÈ£¸£¸ó(thyroid stimulating hormone; TSH)À» ³·Ãß¾î °©»ó¼±¾Ï¼¼Æ÷ÀÇ ¼ºÀå ¾ïÁ¦¸¦ µµ¸ðÇÑ´Ù. ÇÏÁö¸¸ ÀÌ ±Ç°í»çÇ×Àº ÁÖ·Î °©»ó¼± ÀüÀýÁ¦¼ú ȯÀÚµéÀ» ´ë»óÀ¸·Î ÇÑ ¿¬±¸°á°úµéÀ» ±â¹ÝÀ¸·Î ÇÑ °ÍÀ¸·Î, ¿±ÀýÁ¦¼úÀÌ ÁÖ·Î Àç¹ß À§Ç輺ÀÌ ³·Àº ȯÀÚ¿¡¼­ ÀÌ·ç¾îÁø´Ù´Â Á¡¿¡¼­ µ¿ÀÏÇÏ°Ô Àû¿ëÇÒ ¼ö Àִ°¡¿¡ ´ëÇؼ­´Â ³í¶õÀÇ ¿©Áö°¡ ÀÖ´Ù.

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  ÃÖ±Ù ¿±ÀýÁ¦¼úÀÌ ´Ã°í ÀÖ´Â »óȲ¿¡¼­ ÀϹÝÀο¡ ´ëÇÑ ´ë±Ô¸ð °üÂû¿¬±¸¿Í ü°èÀû ¹®Çå °íÂû °á°ú ¿±ÀýÁ¦¼ú ½Ã Ç÷Áß TSH¸¦ ¾ïÁ¦ÇÏÁö ¾Ê¾Æµµ Àç¹ßÀ²¿¡ Â÷ÀÌ°¡ ¾ø¾ú´Ù5. ±×·±µ¥ ¿±ÀýÁ¦¼ú ÈÄ 3-6°³¿ù ° Ç÷Áß TSH 2mIU/L¸¦ ³Ñ´Â ȯÀÚµéÀÌ 82.3%ÀÌ°í 5mIU/L¸¦ ³Ñ´Â ȯÀÚ°¡ 32.3%À̶ó´Â º¸°í´Â TSH 2mIU/L¸¦ ±âÁØÀ¸·Î ÇÒ ¶§ ¿±ÀýÁ¦¼úÀ» Çصµ °©»ó¼±È£¸£¸óÀ» º¹¿ëÇØ¾ß ÇÏ´Â °æ¿ì°¡ ´ë´Ù¼ö¶ó´Â »ç½ÇÀ» ½Ã»çÇÑ´Ù6.
  ¹Ý¸é¿¡ °©»ó¼±È£¸£¸ó ȤÀº TSH°¡ Á¤»ó¹üÀ§¸¦ ¹þ¾î³¯ °æ¿ì ±×·Î ÀÎÇÑ ¿©·¯ ÇÕº´ÁõÀÌ ¹ß»ýÇÔÀÌ º¸°íµÇ°í ÀÖ´Ù. ÇÑ ¸ÞŸºÐ¼® °á°ú ½É¹æ¼¼µ¿, ½ÉÇ÷°ü°è Áúȯ, ³úÇ÷°ü Áúȯ, »ç¸Á·üÀÇ À§ÇèÀÌ °©»ó¼±¾Ï ȯÀÚ¿¡¼­ À¯ÀÇÇÏ°Ô ³ô¾Ò´Ù7. ¶Ç ´Ù¸¥ ¸ÞŸºÐ¼® °á°ú Æó°æÈÄ ¿©¼º¿¡¼­ °ñ´Ù°øÁõÀÇ À§ÇèÀÌ »ó½ÂÇÏ¿´À¸¸ç8 ƯÈ÷ TSH <0.1mIU/L·Î ¾ïÁ¦ÇÑ °æ¿ì ¶Ñ·ÇÇÑ °ñ¹Ðµµ ÀúÇÏ°¡ È®ÀεǾú´Ù9.

ÀüÇâÀû ´Ù±â°ü ¹«ÀÛÀ§ ¹èÁ¤ ´ëÁ¶ ¿¬±¸ÀÇ Çʿ伺: MASTER ¿¬±¸

  ±âÁ¸ÀÇ ¿¬±¸µéÀº ¿¬±¸´ë»óÀÚ ¼ýÀÚ°¡ Å©Áö ¾Ê°Å³ª TSH¾ïÁ¦ÀÇ Á¤µµ ¹× ±â°£À» ÅëÁ¦ÇÏÁö ¾ÊÀº ÈÄÇâÀû ¿¬±¸µéÀ̾ú±â ¶§¹®¿¡ ¸íÈ®ÇÑ °á·ÐÀ» ³»±â¿¡ ºÎÁ·ÇÑ ¸éÀÌ ÀÖ¾ú´Ù. ÀüÇâÀû ÀÓ»ó ¿¬±¸ÀÇ Çʿ伺ÀÌ ´ëµÎµÇ´ø °¡¿îµ¥ ´ëÇÑ°©»ó¼±ÇÐȸ ÁÖ°ü ´Ù±â°ü ¿¬±¸(¿¬±¸Ã¥ÀÓÀÚ Ãæ³²´ëº´¿ø ±¸º»¼® ±³¼ö)¸¦ ±â¹ÝÀ¸·Î Çѱ¹º¸°ÇÀǷῬ±¸¿ø ȯÀÚÁ᫐ ÀÇ·á±â¼ú ÃÖÀûÈ­ ¿¬±¸»ç¾÷´ÜÀÇ Áö¿øÀ» ¹Þ¾Æ ÀÓ»óÇöÀå°ú º¸°ÇÀÇ·áÁ¤Ã¥¿¡ ÇÊ¿äÇÑ °úÇÐÀû ±Ù°Å ¸¶·ÃÀ» À§ÇÑ ÀüÇâÀû ÀÓ»ó ¿¬±¸°¡ ½ÃÀ۵Ǿú´Ù(¿¬±¸Ã¥ÀÓÀÚ ¼­¿ï´ëº´¿ø ¹Ú¿µÁÖ ±³¼ö).
  MASTER ¿¬±¸(A Multicenter randomized controlled study for Assessing the usefulness of Suppressing Thyroid stimulating hormone target levels after thyroid lobEctomy in low to intermediate Risk thyroid cancer patients)´Â Àü±¹ 23°³ ±â°üÀÇ ³»°ú, ¿Ü°ú, À̺ñÀÎÈÄ°ú µî ¿©·¯ °ú ¿¬±¸ÀÚµéÀÌ Âü¿©ÇÏ¿© ´ÙÇÐÁ¦Àû ¿¬±¸ÀÌ´Ù10. ¿±ÀýÁ¦¼úÀ» ¹ÞÀº °©»ó¼±¾Ï ȯÀÚ 2986¸íÀ» µîÀçÇÏ¿© ÀúTSH±º(2uIU/mL¹Ì¸¸)°ú °íTSH±º(2uIU/mL ÀÌ»ó)À¸·Î 1:1 ¹«ÀÛÀ§¹èÁ¤ÇÑ ÈÄ TSH³óµµ¿¡ µû¶ó °©»ó¼± È£¸£¸ó ó¹æ ¿©ºÎ ¹× ¿ë·®À» Á¶ÀýÇÑ´Ù(±×¸² 2). ÃßÀû °üÂû ±â°£µ¿¾È ¾ç ±ºÀÇ Àç¹ß, ÇÕº´Áõ, »îÀÇ Áú, ºñ¿ë-È¿°ú¿¡ ´ëÇØ ºñ±³ ºÐ¼®ÇÒ ¿¹Á¤À¸·Î 2021³â 9¿ù ÇöÀç±îÁö 954¸í (31.9%)¸¦ µîÀçÇÏ¿´´Ù.

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MASTER ¿¬±¸ Âü¿©±â°ü (°¡³ª´Ù ¼ø) ¹× ¿¬±¸ÀÚ (±â°üÃ¥ÀÓÀÚ, ÀÌÇÏ °¡³ª´Ù ¼ø): °­³²¼¼ºê¶õ½ºº´¿ø (ÀåÇ×¼®,±è¼®¸ð,À±ÇõÁØ,ÀÌ¿ë»ó,ÀåÈ£Áø), ±¹¸³¾Ï¼¾ÅÍ (ÀÌÀº°æ, ·ùÁؼ±, ¼®ÁØ°É, À¯Ã¢È¯, ÀÌ¿µ±â, ÀÌÀ¯Áø, Á¤À¯¼®), ³ë¿øÀ»Áö´ëÇб³º´¿ø (±èÈ¿Á¤,Á¤°æ¿¬,Á¤¾Æ¶ó), ´Ü±¹´ëÇб³º´¿ø (À¯¿ø»ó, ¿ì½ÂÈÆ, Á¤Çö°æ), ´ë±¸Ä«Å縯´ëÇб³º´¿ø (±è¼º¿ì, Àü¾ðÁÖ, Á¤¿µÁÖ), ºÎ»ê´ëÇб³º´¿ø(±èº¸Çö,±è¹ÌÁø,½Å¼ºÂù, À̺´ÁÖ), ºÎ»ê¹éº´¿ø (ÇÏűÇ, ¹ÚÇÏ°æ), ºÐ´ç¼­¿ï´ëÇб³º´¿ø (ÃÖÁØ¿µ, ¹®ÀçÈÆ, ¾Èâȣ, À¯Çü¿ø), »ï¼º¼­¿ïº´¿ø(±è¼±¿í), ¼­¿ï´ëÇб³º´¿ø(¹Ú¿µÁÖ, ±è¼öÁø, ¹Ú¼ö°æ, ¾È¼øÇö, ¾ÈÁ¾Çõ, À̱Ծð, Á¤ÀºÀç), ¼­¿ï´ëÇб³º¸¶ó¸Åº´¿ø(ÀÌ°¡Èñ, 俵ÁØ), ¼­¿ï¼º¸ðº´¿ø(¹èÀÚ¼º, ±è±¤¼ø, ±èÁ¤¼ö, ÀÓµ¿ÁØ, ÇÏÁ¤ÈÆ), ¼­¿ï¾Æ»êº´¿ø (Á¤±â¿í), ¼¼Á¾Ãæ³²´ëº´¿ø (¿øÈ£·û, ±èÁö¹Î, ÀÌÀ±ÁÖ, Á¤°æÇý), ½ÅÃ̼¼ºê¶õ½ºº´¿ø (³²±âÇö, ±èÁø°æ), À»Áö´ëÇб³º´¿ø (È«ÁØÈ­), ÀÌ´ë¼­¿ïº´¿ø (¹é¼¼Çö, ±èÁ¾±Ô), Áß¾Ó´ëÇб³º´¿ø(¾ÈÈ­¿µ), Ãæ³²´ëÇб³º´¿ø(±¸º»¼®, °­¿¹Àº, ±èÁ¦·æ, ¼Û¹ÎÈ£, ÀÌÁÖÈñ, ÀåÀç¿ø), ÃæºÏ´ëÇб³º´¿ø (±¸À¯Á¤, ¹ÚÁø¿ì), ÇѸ²´ëÇб³¼º½Éº´¿ø(¼­¿ëÁØ, À̼ºÁø, Á¶À±°æ)

Âü°í¹®Çå

1. Hong S, Won Y-J, Lee JJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2018. Cancer Research and Treatment: Official Journal of Korean Cancer Association 2021; 53(2): 301.

2. Lee YK, Hong N, Park SH, et al. The relationship of comorbidities to mortality and cause of death in patients with differentiated thyroid carcinoma. Scientific reports 2019; 9(1): 1-10.

3. Yi KH. The revised 2016 Korean Thyroid Association guidelines for thyroid nodules and cancers: differences from the 2015 American Thyroid Association guidelines. Endocrinology and Metabolism 2016; 31(3): 373-8.

4. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26(1): 1-133

5. Lee MC, Kim MJ, Choi HS, et al. Postoperative Thyroid-Stimulating Hormone Levels Did Not Affect Recurrence after Thyroid Lobectomy in Patients with Papillary Thyroid Cancer. Endocrinol Metab (Seoul) 2019; 34(2): 150-7.

6. Bae MR, Nam SH, Roh J-L, Choi S-H, Nam SY, Kim SY. Thyroid Stimulating Hormone Suppression and Recurrence After Thyroid Lobectomy For Papillary Thyroid Carcinoma. 2021.

7. Lee EK, Ahn HY, Ku EJ, et al. Cardiovascular outcomes in thyroid cancer patients treated with thyroidectomy: A meta-analysis. The Journal of Clinical Endocrinology & Metabolism 2021.

8. Ku EJ, Yoo WS, Lee EK, et al. Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis. The Journal of Clinical Endocrinology & Metabolism 2021.

9. Kwak D, Ha J, Won Y, Kwon Y, Park S. Effects of thyroid-stimulating hormone suppression after thyroidectomy for thyroid cancer on bone mineral density in postmenopausal women: a systematic review and meta-analysis. BMJ Open 2021; 11(5): e043007.

10. Lee EK, Kang YE, Park YJ, et al. A Multicenter, Randomized, Controlled Trial for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid Lobectomy in Low to Intermediate Risk Thyroid Cancer Patients (MASTER): A Study Protocol. Endocrinol Metab (Seoul) 2021; 36(3): 574-81.