Malignant ectopic thyroid tissue with distant metastasis: a case report

Introduction: Ectopic thyroid tissue is the most common form of thyroid dysgenesis. But primary malignant transformation in ectopic thyroid tissue is quite a rare entity, with follicular malignancy being the dominant form at ectopic sites. Very infrequently, malignant ectopic thyroid tissue can present with metastasis to lymph nodes. But we report a case of malignant ectopic thyroid tissue over manubrium sterni with distant metastasis. Case presentation: A 42-year-old Pakistani female presented with gradually increasing swelling on anterior aspect of manubrium sterni for last 6 months. She had no goitre and was clinically and biochemically euthyroid. Rest of systemic exam was also unremarkable. CT chest showed a circumscribed soft tissue density mass arising from sternum, measuring 3.9×3.9 cm, causing erosions of anterior, right lateral and posterior walls of sternum. Trucut biopsy of the sternal mass proved it to be thyroid tissue with follicular differentiation and occasional mitotic figures. Multiple nodules were also noted in thyroid gland in US neck. She underwent total thyroidectomy and excision of ectopic thyroid tissue over manubrium sterni. Extensive histopathological examination of primary thyroid gland showed benign nodular hyperplasia with no evidence of malignancy. Ectopic thyroid tissue showed minimally invasive follicular thyroid carcinoma with tumor size of 3.2×2.3 cm. Her postoperative 21-day biochemical profile showed TSH 22.345 μIU/ml (0.4–4.2), serum thyroglobulin 88.3 ng/ml, and anti-TG antibodies Conclusion: We describe the first case of its kind having malignant ectopic thyroid with metastasis to spine and ilium. Such cases may impose difficulties in their treatment decisions

Patterns, control and complications of diabetes from a hospital based registry established in a low income country.

Background: Diabetes registry enables practitioners to measure the characteristics and patterns of diabetes across their patient population. They also provide insight into practice patterns which can be very effective in improving care and preventing complications. The aim of this study was to assess the patterns, control levels and complications at the baseline of the patients attending clinic at the large tertiary care hospital in Karachi, Pakistan with the help of the registry. This can be used as a reference to monitor the control and also for a comparison between peer groups. Methods: This was a cross sectional study with the data obtained from diabetes registry collected with the help of pre-designed questionnaire. HbA1c was used as a central diabetes measure and other related factors and complications were assessed with it. Results: Only 16.6% of the participants had optimal HbA1c≤7.0%. 52.9% of the patients were classified as having poor control defined by HbA1c of \u3e8%. Three fourth of the study population were obese according to Asian specific BMI cutoffs and majority had type 2 diabetes with duration of diabetes ranging from less than one to about 35 years, mean(SD) duration being 7.6 years (7.1). Overall only 4% of the patients were on combine target of HbA1c, LDL and BP.Results of multivariable logistic regression showed that the odds of having optimal glycemic control increased by 3% with every one year increase in age. In addition, having longer duration of diabetes was associated with 56% lower odds of having good glycemic control. Moreover, having higher triglyceride levels was associated with 1% lower odds of having good glycemic control. Conclusion: This highlights the large burden of sub optimally controlled people with diabetes in Pakistani population, a low income country with huge diabetes prevalence and ineffective primary health care system creating enormous health and economic burden

Genetics of Puberty

Puberty is the physical transition in the maturation process experienced by adolescents. It is a complex process that requires a closely regulated interplay of genetic, metabolic, hormonal, and environmental mechanisms. The usual onset of puberty follows a set sequence of physical maturation, but some variability occurs between individuals with regard to timing, order, and tempo of this maturation process. Genetics accounts for the majority of this variability. Several genetic loci have now been identified that are associated with the age of onset of puberty. Major advancements have been made in identifying the different genes implicated in the pathophysiology of puberty. Despite these significant advances in understanding the genetics of puberty, a lot of the genetic basis still remains unexplained. Also, there seems to be a significant role of metabolic and environmental factors working in close collaboration with genetic factors in this complicated process of pubertal onset. This chapter will focus on the physiology of puberty, highlighting the role of various genetic factors, and their interplay with hormonal, metabolic, and other environmental factors

Diagnostic characteristics and management outcome in patients with acromegaly: A 15-year experience at a tertiary care hospital in Pakistan

Objective: To assess the diagnostic features of acromegaly, and analyse its management outcomes over a 15-year period in a tertiary care setting.Methods: The descriptive, cohort, retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of adult patients of either gender diagnosed with acromegaly based on biochemical and radiological evidence between January 2005 and December 2019. Data was retrieved from the medical records. Data was analysed using SPSS 19.Results: Of the 84 subjects, 54(64.3%) were males and 30(35.7%) were female. The overall mean age was 38.69±13.52 years. The patients presented 5.43±4.3 years after the onset of symptoms, with somatic growth features, such as enlarged hands and feet which was the most common complaint 81(96.4%). Of all the patients, 73(86.9%) underwent trans-sphenoidal surgery for the removal of the pituitary adenoma, while 11(13.1%) opted out of the surgical option. Further, 9(12.3%) patients showed biochemical and radiological remission 6 months post-surgery. Out of the remaining 64(87.7%) patients, 38(59.4%) received radiosurgery or radiotherapy, 15(23.4%) underwent repeat trans-sphenoidal surgery, and 11(17.2%) chose medical treatment.Conclusions: Majority of patients failed to achieve remission after trans-sphenoidal surgery, which is the first line of treatment. Radiotherapy/repeat surgery was generally the options taken by those with persistent disease

Additional file 1: of Patterns, control and complications of diabetes from a hospital based registry established in a low income country

Questionnaire used in the study. (PDF 1000 kb