A 39-year diabetic, for six months had primary hypothyroidism three
years ago, normalized with thyroxine. Seventeen months later he was
hyperthyroid, reversed by carbimazole (30 mg/d) and recurred on stopping.
His thyroid microsomal antibody was positive (1:25,600).
Thyroid disorders were present in 6.9% adult diabetics in Edinburgh
(1). Type 2 diabetes was seen in 7.6% patients with Grave’s thyrotoxicosis
in Ja...
A 39-year diabetic, for six months had primary hypothyroidism three
years ago, normalized with thyroxine. Seventeen months later he was
hyperthyroid, reversed by carbimazole (30 mg/d) and recurred on stopping.
His thyroid microsomal antibody was positive (1:25,600).
Thyroid disorders were present in 6.9% adult diabetics in Edinburgh
(1). Type 2 diabetes was seen in 7.6% patients with Grave’s thyrotoxicosis
in Japan (2).
In our database of endocrine diseases, among 8225 diabetics 73 had
thyroid disorders (0.89%): 65 had hypothyroidism (65/73; 89%), and eight
thyrotoxicosis (8/73;11%). Out of 1777 persons with thyroid disorders 31
had diabetes mellitus (1.74%; 16 had hypothyroidism (51.6%), eight
thyrotoxicosis (25.8%) and seven other conditions.)
Consanguinity (2) , increasing age, when thyroid diseases are
common, and some type 2 diabetic patients being slow-onset type 1 diabetic
were implicated (3).
Hypothyroidism going into hyperthyroidism is unusual. It is likely
due to the switch of blocking antibodies replaced by stimulatory
antibodies to TSH and resultant hyperthyroidism (5).
References:
1. Perros P, McCrimmon RJ, Shaw G, Frier BM. Frequency of thyroid
dysfunction in diabetic patients: value of annual screening. .Diabetic Med
1995;12:622-7
2. Komiya I, Takasu N, Yamada T, Ohara N, Ootsuka H, Ota M, Fukushima
H, Sekikawa A, Tominaga M, Sasaki H. Studies on the association of NIDDM
in Japanese patients with hyperthyroid Grave’s disease. Horm Res
1992;38:264-8
3. Jaworski MA, Slater JD, Severini A, Henning KR, Mansour G, Mehta
JG, Jeske R, Schlaut J, Pak CY, Yoon JW. Unusual clustering of diseases in
a Canadian Old Colony (Chortitza) Mennonite kindred and community. CMAJ
1988;138:1017-25
4. McKenzie JM, Zakarija M. Antibodies in autoimmune thyroid disease.
In Braverman LE, Utiger RD (eds). Werner and
The excellent case report on verrucous carcinoma is not only of value
because of being a "first" on tumours of the female breast (1), but also
of focussing attention on this condition.
A myth was unintentionally started by Perez-Meza in 1966 (2)
when they suggested that there may be a possibility that this tumour could
be aggravated by radiation therapy. This started a misconception which is
still widely believed...
The excellent case report on verrucous carcinoma is not only of value
because of being a "first" on tumours of the female breast (1), but also
of focussing attention on this condition.
A myth was unintentionally started by Perez-Meza in 1966 (2)
when they suggested that there may be a possibility that this tumour could
be aggravated by radiation therapy. This started a misconception which is
still widely believed and propagated in the world literature (2).
Whereas surgery still remains the treatment of choice for small
verrucous carcinoma wherever it may occur, radiotherapy is an acceptable
choice of treatment. However, a dose of 50 Gray in fractions of 2 Gray
treating 5 days a week is not enough to control this disease. Despite
being a low grade malignant lesion which rarely if ever metastasizes the
larger dose of 60 Gray is preferred and is in fact mandatory. The disease
will recur if only 50 Gray is given.
References:
1. Munro RA et.al., PMJ 1999;75:674-675
2. Reinecke L & Thornley A L. Review: Radiotherapy as an effective
treatment for vaginal verrucous carcinoma. Brit J Radiol 1993;66:375-374
A 39-year diabetic, for six months had primary hypothyroidism three years ago, normalized with thyroxine. Seventeen months later he was hyperthyroid, reversed by carbimazole (30 mg/d) and recurred on stopping. His thyroid microsomal antibody was positive (1:25,600).
Thyroid disorders were present in 6.9% adult diabetics in Edinburgh (1). Type 2 diabetes was seen in 7.6% patients with Grave’s thyrotoxicosis in Ja...
The excellent case report on verrucous carcinoma is not only of value because of being a "first" on tumours of the female breast (1), but also of focussing attention on this condition.
A myth was unintentionally started by Perez-Meza in 1966 (2) when they suggested that there may be a possibility that this tumour could be aggravated by radiation therapy. This started a misconception which is still widely believed...
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