Clinicopathologic Characteristics of Thyroid Microcarcinoma: Findings from a Hospital-Based Study in Vietnam.

BACKGROUND: Thyroid microcarcinoma (TMC) incidence has significantly increased in recent decades. The rates of lymph node metastasis extrathyroidal extension have been significantly different in patients with TMC ≤5 mm versus those with size >5 mm. The current analysis aimed to examine the clinicopathologic features of TMC measuring <5 mm and to compare them with those of TMC ≥5 mm. METHODS: A total of 273 patients with TMC confirmed by histological examination from December 2020 to May 2021 were enrolled in Bach Mai Hospital, Hanoi, Vietnam. Unconditional logistic regression models were used to determine the association between clinicopathological factors and tumor size, central lymph node metastasis and extrathyroidal extension. RESULTS: We found 212/273 patients (77.7%) were diagnosed incidentally. The majority of patients were female (87.5%) and had a mean age of 44.2 years. The mean tumor size (±standard deviation (SD)) was 5.72 ± 2.33 mm. Most of the patients were also diagnosed with papillary TMC. Multifocal and bilateral lesions accounted for 13.2% and 12.1%, respectively. The extrathyroidal invasion was observed in 14.7% (40 patients), while 24.5% (67 patients) were those with central lymph node metastases. The rate of extrathyroidal extension in patients with tumor size ≥5 mm was significantly higher than in patients with tumor size <5 mm (odds ratio (OR) = 4.98; 95% confidence interval (CI): 1.48-16.70; p = 0.004). Patients with body mass index (BMI) <23 kg/m2 were found to be protected against the odds of extrathyroidal extension (OR = 0.38, 95% CI: 0.19-0.75; p = 0.004) compared to those with BMI ≥23 kg/m2. In univariable mode, central lymph node metastasis was positively associated with the odds of the presence of extrathyroidal extension (OR = 2.70, 95% CI: 1.34-5.45; p = 0.004). In the multivariable model, central lymph node metastasis was also associated with the presence of extrathyroidal extension (OR = 2.507, 95% CI: 1.194-5.264; p = 0.017). Univariate analysis demonstrated that tumor size ≥5 mm (OR = 2.04; 95% CI: 1.01-4.17; p = 0.047) and extrathyroidal extension (OR = 2.71; 95% CI: 1.34-5.45; p = 0.004) were risk factors of central cervical lymph node metastasis. In multivariable models, the extrathyroidal extension was associated with central lymph metastasis. CONCLUSIONS: TMC <5 mm tumor size is less likely to have aggressive characteristics, including extrathyroidal extension, than a TMC ≥5 mm. Long-term follow-up studies are thus warranted to investigate the factors in the prognosis of TMC.

Clinical, cytological and ultrasonographic features of incidental thyroid cancer in a hospital-based study in vietnam.

INTRODUCTION: Thyroid nodules are common diseases of the endocrine system, with a 5% prevalence rate in the general population. This study aimed to identify prevalence, clinical, cytological and ultrasonographic features of incidental thyroid cancer and its associated factors in Vietnam. METHODS: This cross-sectional descriptive study consisted of 208 patients with incidental thyroid nodules detected by ultrasound at the Endocrinology Department, Bach Mai Hospital, Hanoi, Vietnam between November 2019 and August 2020. Clinical information, sonography characteristics of thyroid nodules, results of fine-needle aspiration biopsy (FNAB), postoperative pathology and lymph node metastasis were collected. A multiple logistic regression model was used to estimate factors associated with thyroid cancer. RESULTS: A total of 272 thyroid nodules (from 208 participants) were included in this study. The mean age was 47.2 ± 12.0 (years). The rate of incidental thyroid cancer patients detected was 17.3%. Nodules <1 cm in size were significantly more prevalent for malignant nodules. The size of more than half of thyroid cancer nodules was 0.50-0.99 cm. Postoperative pathology of all nodules with Bethesda V and VI was papillary thyroid cancer which was consistent with cytological results. 33.3% of thyroid cancer patients have lymph node metastasis. The regression model showed that thyroid cancer was more likely to occur at a younger age (≤ 45 years vs. >45 years, OR 2.8; 95% CI: 1.3-6.1), taller-than-wide nodules (OR 6.8; 95% CI: 2.3-20.2) and hypo-echoic nodules (OR 5.2; 95% CI: 1.7-15.9). CONCLUSION: The study showed that the prevalence of incidental thyroid cancers was 17.3%, of which 100% was papillary carcinoma. People under the age of 45 and the presence of ultrasound characteristics, such as taller-than-wide and hypoechoic nodules increased risk for malignancy.

Successful management of severe diabetic ketoacidosis in a patient with type 2 diabetes with insulin allergy: a case report.

BACKGROUND: Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that requires immediate treatment. Allergic reaction to insulin is rare, especially when using recombinant human insulin. The clinical presentation of insulin allergy can range from minor local symptoms to a severe generalized allergic reaction such as anaphylaxis. A limited number of cases have been reported on the treatment of severe DKA in patients with type 2 diabetes with insulin allergy. Here, we describe a patient with type 2 diabetes with insulin allergy in which severe DKA resolved after the initiation of continuous intravenous (IV) recombinant human insulin infusion. CASE PRESENTATION: A 58-year-old man with type 2 diabetes initiated subcutaneous insulin administration (SIA) after failure of oral antidiabetic treatment. Symptoms of an allergic reaction developed, including pruritic wheals appearing within 10 min of injection and lasting over 24 h. Both skin prick and intradermal tests were positive with different types of insulin. Two days before admission, he stopped SIA because of allergic symptoms and then experienced weakness and upper abdominal pain. On admission, he was in severe metabolic acidosis with a pH of 6.984 and bicarbonate of 2.5 mmol/litre. The blood glucose level was 20.79 mmol/litre, BUN 4.01 mmol/litre, creatinine 128 µmol/litre, and urinary ketone 11.44 mmol/litre. Over 24 h, metabolic acidosis was refractory to IV fluids, bicarbonate and potassium replacement, as well as haemodialysis. Ultimately, he received continuous IV recombinant human insulin infusion at a rate of 0.1 units/kg/hour, in combination with haemodiafiltration, and no further allergic reactions were observed. On day 5, ketonaemia and metabolic acidosis completely resolved. He had transitioned from IV insulin infusion to SIA on day 14. He was discharged on day 21 with SIA treatment. Three months later, he had good glycaemic control but still had allergic symptoms at the insulin injection sites. CONCLUSIONS: In this patient, SIA caused an allergic reaction, in contrast to continuous IV insulin infusion for which allergic symptoms did not appear. Continuous IV recombinant human insulin infusion in combination with haemodiafiltration could be an option for the treatment of severe DKA in patients with diabetes with insulin allergy.