Background. Post-thyroidectomy hypocalcemia is the most common complication after total thyroidectomy. Studies to examine the role of low vitamin D in increasing post-thyroidectomy hypocalcemia incidence have produced varying results. This study aimed to assess whether vitamin D deficiency increases the risk of post-thyroidectomy hypocalcemia. Methods. This retrospective study involved 244 patients who underwent total thyroidectomy between 2014 and 2019. Patients were divided into two groups based on pre-operative vitamin D levels. Group A and Group B had pre-operative vitamin D (25-hydroxyvitamin D) levels of ≥20 ng/ml and <20 ng/ml (reference range for vitamin D is 30–100 ng/dl). The effect of vitamin D, gender, body mass index (BMI), and ethnicity on post-operative calcium and PTH levels was analyzed. Results. Post-operative calcium levels for Group A were not statistically different compared to Group B (8.52 ± 0.64 mg/dl vs. 8.45 ± 0.58 mg/dl (mean ± S.D.; p value = 0.352). The average post-operative PTH of the two groups did not differ significantly (Group A: 32.4 ± 27.5 pg/ml; Group B: 34.4 ± 41.7 pg/ml; p value = 0.761). Conclusion. Pre-operative vitamin D levels are not predictive of post-thyroidectomy hypocalcemia.
Testicular cancer is seen commonly in young males and has a high cure rate if diagnosed and treated early. It clinically presents with painless testicular swelling. We discuss the case of a young previously healthy male with an aggressive testicular cancer which started with a testicular swelling but the primary site underwent necrosis secondary to its own vascular demand thus giving the false impression of resolution, but not before metastasizing to the rest of the body. With this case, we aim to highlight the importance of increasing awareness of testicular cancer and its presenting symptoms in young males and the need to overcome the stigma around the evaluation of testicular swellings.
Cushing's disease (CD) is the most common cause of endogenous cortisol excess. We discuss the case of a 60-year-old woman with recurrent venous thromboembolism, refractory hypokalemia, and lumbar vertebrae compression fractures with a rapidly progressive disease course. Ectopic hypercortisolism was suspected given the patient's age and rapid onset of disease. Investigations revealed cortisol excess from a pituitary microadenoma. This case demonstrates that CD can present with severe findings and highlights the increased risk of venous thromboembolism in hypercortisolism, especially in CD.
Cholangiocarcinoma is one of the most lethal tumors because of its complex location and lack of good chemoradiotherapy options. When it is diagnosed, urgent intervention is needed, often involving radical surgical resection. It generally presents as a liver mass with biliary obstruction. We discuss the case of a young patient presenting with liver dysfunction and imaging mimicking a liver mass concerning for cholangiocarcinoma, where he actually had a liver infarct from splanchnic venous thrombosis from primary myelofibrosis.
Familial adenomatous polyposis (FAP) is an inherited disease that is characterised by multiple recurrent cancers of the colon (large intestine). Thyroid nodules and thyroid cancer are among the few extraintestinal manifestations of FAP, with a prevalence of 35-80% and 3-12% respectively. The incidence of thyroid cancer is higher in FAP patients than in the general population. However, routine thyroid cancer screening is not consistently performed by most practitioners when managing patients with FAP. We sought to assess the frequency of thyroid cancer screening among patients with FAP and the prevalence of thyroid cancer among these patients. We performed a retrospective chart review of all adult patients with FAP, between January 2000 and December 2016 at our center. 51 patients were identified with a confirmed diagnosis of FAP based on colonoscopy and pathology criteria. Of the 51 patients with FAP syndrome, only 14 patients had thyroid ultrasound performed, and 3 patients were found to have thyroid cancer. With limited data, our analysis showed a reduced prevalence of thyroid cancer of 5% when compared to historical data. Most adult FAP patients did not get thyroid cancer screening and this could be due to lack of awareness in medical providers on the increased incidence of thyroid cancer and FAP. Every clinician managing FAP patients should be educated on the increased risk of thyroid cancer in FAP and the role of thyroid ultrasound screening for early detection of thyroid cancer.
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