A 70-year-old male was referred with hyperthyroidism and multinodular goiter (MNG). Thyroid ultrasonography showed 2 nodules, one in the isthmus and the other in the left lobe, 51 and 38 mm in diameter, respectively. Neck CT showed a large MNG, thyroid scintigraphy showed increased uptake in the nodule in the left lobe, and fine-needle aspiration biopsy showed a benign cytology of the nodule in the isthmus. The patient declined surgery and was treated with methimazole. After being lost to follow-up for 3 years, the patient returned with complaints of dyspnea, dysphagia, and hoarseness; he was still hyperthyroid. Cervical CT showed a large mass in the isthmus and left lobe with invasion of surrounding tissues, the trachea, the esophagus, and the recurrent laryngeal nerve. Bronchoscopy showed extensive infiltration and compression of the trachea to 20% of its caliber. A tracheal biopsy revealed an anaplastic thyroid carcinoma. The tumor was considered unresectable, and radiotherapy was given. One month later, the patient died. The association between a toxic thyroid nodule and anaplastic thyroid carcinoma has apparently not been reported so far.
Type 2 diabetes is a heterogeneous disease for which etiological mechanisms are incompletely understood and subclassification may improve patient care. In this paper, we aimed to stratify a cohort of Portuguese patients with adult-onset diabetes followed at our Diabetic clinic into subgroups and assess the impact of the clusters on outcomes and therapy. Methods: We performed a cluster analysis on 1280 patients followed at our Diabetic clinic. Clusters were based on three variables: presence of glutamic acid decarboxylase antibodies, age at diagnosis and body mass index. Clinical data was retrieved from patient records. Statistical analysis was performed using SPSS v.25.0. Results: We identified four replicable clusters of adult-onset diabetes, with significantly different patient characteristics and risk of diabetic complications. Clusters 1 and 2 were characterized by early-onset disease, higher HbA1c and insulin treatment. More than half of patients were included in cluster 3, requiring combined therapy. Cluster 4 was characterized by late-onset disease, low HbA1c and monotherapy. Cluster 1 had the highest risk of retinopathy.
Conclusion:The recently proposed cluster analysis is easily replicable in real-world clinical practice and applicable to different populations, including other Portuguese settings. This new subclassification may contribute patient tailored therapy, therefore representing a first step towards precision medicine in type 2 diabetes.
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