The decrease of T3 / T4 is not hypothyroidism - a new mutation of Serpina7 gene results in partial thyroglobulin deficiency.

To explore an unusual cause of the decrease of T3/T4 through a new mutation of TBG gene in a family, so as to avoid habitual thinking and reduce subsequent over treatment. TSH, free total T4, T3 and free T4, T3 were determined by automatic chemiluminescence immunoassay. The TBG mutation was identified by direct DNA sequencing. A frameshift mutation of p. l372ffs * 32 was found in the TBG gene (c.1114delc) of the patient by direct DNA sequencing, and the proband of the family was heterozygous. In vitro expression showed that the affinity of TBG for T4 decreased. Further examination of the family members showed that T3 and T4 were decreased, while FT3, FT4 and TSH were normal. If the patients with low TT4 and TT3 but normal TSH are found, the serum TBG level and related genes should be detected to determine whether it is TBG deficiency and avoid wrong treatment.

Multifocal lipoatrophy secondary to insulin injection in a patient with type 2 diabetes, hepatitis B virus infection, and liver cirrhosis.

Lipoatrophy secondary to insulin injection is a rare complication of insulin use. Localized lipoatrophy is recognized by a loss of subcutaneous fat caused by insulin injection. We report the case of a 69-year-old non-obese female patient with type 2 diabetes mellitus, decompensated liver cirrhosis, and hepatitis B virus (HBV) infection who developed multifocal lipoatrophy during the administration of human insulin and an insulin analog.