ML：Memorial of Prof. Jen-Der Lin

ML-1 MEMORIAL OF PROF. JEN-DER LIN: TO SIR, WITH LOVE

FENG-HSUAN LIU

Division of Endocrinology & Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan

Professor Jen-Der Lin was born on December 13, 1953 and died on September 4, 2019. He was graduated from the department of medicine of Kaohsiung Medical University in 1980. He completed the training courses of Internal Medicine (1980~1983) and Endocrinology & Metabolism (1983~1985) at Chang Gung Memorial Hospital (CGMH), Linkou. He was the director of Endocrinology & Metabolism between 1993 and 2003. During the period, he was also the director of the health department (1997~1998) and the director of the nutrition therapy department (2000~2003). And from 2001 to 2007, he was also the deputy minister of Internal Medicine.

Professor Lin brought together Taiwan’s largest thyroid cancer database, led colleagues to publish dozens of clinical papers, and summarized them into cancer management guidelines. He completed the registration of thyroid cancer and acromegaly cases. He also organized and systematized of clinical case seminars by integrated department of surgery, pathology, and radiology in CGMH. He had 245 peer review papers, 54 research projects; 33 honorable guest speaker; 37 major medical journals as the reviewer.

He started as the seventh standing executive board (1998~2001), and was later elected to serve as two-term president of Endocrine Society of ROC (2001~2007). From 2007 to 2019, he had been as standing control board. Professor Lin’s contributions during his tenure as president: established a dedicated email account; expanded the function of the website; invited foreign scholars to Taiwan; actively participate in exchanges between Huaxia, Asia, and the International Endocrine Society; actively participate in publications abroad; strengthen the bridge between the clinical and basic research.

We remember our teacher here, hoping that future generation will understand his attitude of pursuing knowledge is broad and deep. He has his principle and persistence in handling things. He is a typical clinician, but his research has moved beyond basic medicine.

ML-2 MEMORIAL OF PROF. JEN-DER LIN: PROF. LIN’S ACADEMIC RESEARCH AND PROSPECT

SHU-FU LIN

Division of Endocrinology and Metabolism, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation)

Professor Jen-Der Lin was a kind and generous physician who devoted in the basic and clinical research for more than 3 decades. He initiated his first study addressing the epidemiology of diabetes mellitus and hypertension in Keelung in 1988. Since then, he conducted more than 46 research projects. The scopes of his study included epidemiology, establishment and characterization of human thyroid cancer cell lines, evaluation of therapeutic effects of various drugs in the treatment of thyroid cancer cells, assessment of biologic behavior and genetic expression of thyroid cancer cells, and conducting clinical trials to evaluate therapeutic effects of various agents for acromegaly and diabetes. In addition, he had established a thyroid cancer registry at Chang Gung Memorial Hospital in 1976. This dataset consisted of more than 5000 patients managed at this institute between 1976 and 2018. His first paper entitled “Analysis of diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic coma” was published in 1985. Until 2019, he had published more than 240 peer-reviewed papers in 114 journals, including British Medical Journal and Thyroid.

Prof. Lin served as the chief of Thyroid Cancer Team at Chang Gung Memorial Hospital for more than 10 years. Under his guidance and supervision, the quality of care for patients with thyroid cancer achieved an exceeding level at this medical center.

In the future, we will continue doing medical research and providing high-quality of care for patients to meet Prof. Lin’s expectations.

ML-3 THYROID CANCER AND RADIOACTIVE IODINE THERAPY

SHENG-FONG KUO

Department of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Taiwan

Radioactive iodine therapy has been extensively used for more than 60 years in the treatment of differentiated thyroid cancer after total or near-total thyroidectomy, and is suggested for remnant ablation in high and intermediate-risk patients with differentiated thyroid cancer. Under the Professor Lin's guidance, we performed studies at the Chang Gung Memorial Hospital regarding to “Thyroid cancer and radioactive iodine therapy”.

Although radioactive iodine therapy is generally accepted in the management of patients with papillary thyroid carcinoma postoperatively, the data regarding radiation exposure to the household environment from patients with thyroid cancer who received radioactive iodine therapy were still insufficient, and also the factors associated with radiation exposure from the patients to the household environment, our study showed higher body weight and distant metastases may be the best predictors for higher radiation exposure to the household environment from patients with thyroid cancer after radioactive iodine therapy.

In addition, the policy toward radioactive iodine therapy in childhood with papillary thyroid carcinoma is varied because of the unwanted side-effects of radiation exposure in young patients and limited long-term data. The prognosis of young PTC patients is generally good. Postoperative radioactive iodine therapy is effective in young papillary thyroid cancer patients especially those with distant metastases. Radioactive iodine therapy should be given to all young papillary thyroid cancer patients postoperatively in addition to thyroid hormone administration.

ML-4 CIRCULATING EPITHELIAL CELLS FOR RECURRENCE OF PAPILLARY THYROID CARCINOMA WITH POSITIVE ANTI-THYROGLOBULIN ANTIBODY

YAN-RONG LI

Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taiwan

Serum thyroglobulin (Tg) is a routine and useful test to monitor disease status in papillary thyroid carcinoma (PTC) patients after total or near-total thyroidectomy with or without RAI therapy. However, for patients with positive serum anti-thyroglobulin antibody (TgAb), serum Tg cannot be a reliable tumor marker for follow-up of recurrent or persistent disease because of highly false negative rate. Positive serum TgAb are present in around 15% of thyroid cancer patients and an elevated titer of TgAb with or without an increased serum Tg suggests a recurrent disease; on the contrary, a significantly decreased titer of serum TgAb suggests no recurrence. Nevertheless, optimal levels of serum TgAb to define recurrent or persistent PTC is still conflicting currently.

Although longitudinal changes in titers of serum TgAb can help physicians in detection of recurrent or persistent disease in progression, considerable time is still needed to observe this trend and this may cause a delayed diagnosis. Therefore, for PTC patients with positive serum TgAb, there remains a critical need to develop new biomarkers to monitor the disease status. Evaluation of circulating epithelial cells (CECs) or circulating tumor cells (CTCs) could be considered as a “liquid biopsy” that can monitor treatment responses and disease status in several types of cancers, such as breast, lung, colorectal and prostate cancers. Because PTC is a tumor of epithelial origin, CECs could be considered as CTCs in a defined population with known PTC. Our preliminary data illustrates that CECs testing could be a potential biomarker to identify recurrences in patients of PTCs with positive serum TgAb and undetectable levels of serum Tg.