Esophageal 99mTc-pertechnetate uptake mimicking an autonomous thyroid adenoma in a patient with subacute thyroiditis: a case report.

Subacute thyroiditis (SAT) is one of the most common causes of thyrotoxicosis. Thyroid scans with radioiodine or technetium-99m pertechnetate (99mTc) are often performed in the workup of patients with thyrotoxicosis, particularly to differentiate between SAT and Graves's disease. Although very helpful, thyroid scans are prone to pitfalls that may occasionally lead to misdiagnosis. These pitfalls are largely related to physiologic uptake of radioiodine or 99mTc in non-thyroidal tissue, such as salivary gland and stomach that may result in false-positive findings. We present herein a very rare case of SAT misdiagnosed as an autonomous thyroid adenoma most likely due to focal 99mTc uptake in the esophagus. This case may have implications for the management of patients with suspected SAT, who undergo a radioiodine or 99mTc thyroid scan.

Predetermined Anti-Diabetic Drug Regimen Adjustments during Ramadan Fasting: An Observational Study of Safety.

BACKGROUND: Many Muslim type 2 diabetes mellitus (T2DM) patients choose to fast the month of Ramadan despite the possible adverse health effects brought about by the change in dietary habits, among other things. Clinical data regarding the safety of multi-drug regimens during fasting are particularly scarce. The aim of the study was to evaluate the safety of a drug protocol devised by the authors to accommodate Ramadan's dietary changes, involving dose adjustments of four anti-diabetic drug regimens in T2DM patients fasting Ramadan. METHODS: In this prospective, observational, open-label study, 301 T2DM patients who wished to fast Ramadan were followed during Ramadan and the preceding month. The incidence of hypoglycemia, diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar state (NKHS) was monitored. Patients were classified into four groups: A group (those taking metformin, sulfonylurea and insulin [n=33]); B group (metformin and sulfonylurea [n=89]); C group (metformin and insulin [n=96]); and D group (premixed 70/30, glargine or regular insulin [n=82]). During Ramadan, drug doses were adjusted as percentages of their pre-Ramadan values: 75% for sulfonylureas, 75% for glargine, 75% for premixed insulin 70/30 in two doses, and 75% for regular insulin. Metformin was adjusted to a twice-daily regimen. RESULTS: No cases of DKA or NKHS were reported. Hypoglycemia occurred at a lower rate than pre-Ramadan values in groups C, and D; and a similar rate in groups A, and B. CONCLUSION: The data suggested that using the above protocol to adjust the doses of anti-diabetic drugs is safe in T2DM patients in regards to hypoglycemia, DKA, and NKHS.