ABSTRACT
A 76-year-old woman with a 10-year history of chronic glomerulonephritis was treated at a clinic after presenting with a gradual worsening of the renal function. The patient had no history of tuberculosis. She was subsequently hospitalized for uremic symptoms and treated with internal shunt insertion and dialysis. Thyroid ultrasonography was performed to screen for secondary hyperparathyroidism, which revealed a calcified thyroid mass and cervical lymph node swelling. Fine-needle aspiration biopsy was thus conducted to assess suspected thyroid cancer. The cytological findings showed few follicular epithelial cells, without any signs of malignancy. However, a diagnosis of thyroid cancer continued to be strongly suspected based on the imaging features. Total thyroidectomy and bilateral cervical regional lymph node dissection were therefore performed, and the pathological examination of the thyroidectomy specimen disclosed scattered epithelioid granulomas with caseous necrosis in the entire right lobe as well as the cervical lymph nodes. Based on these findings, the patient was diagnosed with thyroid tuberculosis. As the symptoms and imaging findings of tuberculosis are nonspecific in elderly patients, it is necessary to consider this disease in this population. We therefore propose the inclusion of thyroid tuberculosis in the differential diagnosis of elderly patients who present with malignant thyroid tumors on aspiration biopsy cytology, regardless of whether or not they have a previous history of tuberculosis.
Subject(s)
Diagnosis, Differential , Thyroid Diseases/diagnosis , Thyroid Neoplasms/diagnosis , Tuberculosis/diagnosis , Aged , Female , Humans , Necrosis , ThyroidectomyABSTRACT
Objective In addition to excess visceral fat, lipid deposition in the liver and skeletal muscle has been implicated in the pathophysiology of type 2 diabetes and metabolic syndrome. This study was designed to explore the relationship between hepatic and muscular lipid deposition and visceral fat accumulation in 105 middle-aged men with metabolic syndrome. Methods Abdominal computed tomography (CT) was used to simultaneously evaluate the visceral fat area (VFA) and CT Hounsfield unit (HU) values of three different portions of skeletal muscle and the liver. Results A significant inverse correlation was observed between the VFA and the CT HU values of the iliopsoas muscle, back muscle, rectus abdominis muscle and liver. Three types of interventions, i.e., lifestyle modification and treatment with antidiabetic drugs, such as Pioglitazone or Miglitol, caused significant decreases in visceral fat accumulation. The extent of lipid deposition in the liver was strongly correlated with the levels of glucose-lipid metabolic markers, which decreased significantly following Pioglitazone treatment. On the other hand, the amount of lipid deposition in the three skeletal muscles and the liver did not decrease after Miglitol treatment. Conclusion Visceral fat accumulation is accompanied by excess lipid deposition in skeletal muscle and the liver in patients with metabolic syndrome. The CT-based simultaneous, concise evaluations of ectopic lipid deposition and visceral fat mass used in the present study may provide unique information for assessing cardiometabolic risks and the therapeutic impact in patients with diabetes-obesity syndrome.
Subject(s)
Fatty Liver/metabolism , Hypoglycemic Agents/therapeutic use , Intra-Abdominal Fat/metabolism , Lipid Metabolism/physiology , Metabolic Syndrome/therapy , Risk Reduction Behavior , Adult , Aged , Fatty Liver/diagnostic imaging , Fatty Liver/therapy , Humans , Intra-Abdominal Fat/diagnostic imaging , Intra-Abdominal Fat/physiopathology , Male , Metabolic Syndrome/diagnostic imaging , Metabolic Syndrome/metabolism , Middle Aged , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/drug effects , Muscle, Skeletal/metabolism , Tomography, X-Ray ComputedABSTRACT
The patient was a 76-year-old, male who was diagnosed with high blood glucose at 30 years of age. He suffered a stroke at 52 years of age. and was diagnosed with type 2 diabetes at a nearby hospital. Oral hypoglycemic medicines were administered along with diet and exercise therapy, which resulted in good glycemic control. The patient required an emergency hospital admission in December 2010 for weight loss. In addition, he suffered from frequent urination. He was diagnosed with diabetic ketoacidosis based on the following findings: blood glucose, 1,003 mg/dL; glycated hemoglobin, 7.7%; positive urine ketone bodies; and blood gas pH, 7.293. Although he had previously received medical treatment, the patient was transferred to our hospital, as he was unable to achieve stable glycemic control. At the time of admission, level of blood glucose and fasting serum C peptide were 1.002 mg/dL and 0.1 ng/mL, respectively. A glucagon loading test performed at our hospital revealed a serum C peptide level of <0.5 ng/ml. Tests for islet-cell autoantibodies were negative, and the patient's pathological conditions met the diagnostic criteria for fulminant type 1 diabetes. His human leukocyte antigen genotype was DRB1*0405 DQB1*0401, which is a disease susceptibility haplotype. In our experience, acute exacerbation of fulminant type 1 diabetes is observed in elderly patients who receive treatment following a diagnosis of type 2 diabetes. The differential diagnosis of ketoacidosis in elderly patients with type 2 diabetes should also include fulminant type 1 diabetes. Furthermore, providing an appropriate diagnosis and rapid treatment intervention is required.
