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Introduction. Grave’s disease (GD) can be treated using three modalities: anti-thyroid medications, radioactive iodine therapy (RAI), or surgery. If surgery is selected, total thyroidectomy is the procedure of choice. Patients with hyperthyroidism frequently have an enlarged thyroid gland, occasionally with a pyramidal lobe. Aim. We point the usefulness of thyroid scintigraphy, which provides valuable information regarding the thyroid anatomy. Description of the case. The manuscript presents a case report of 43-year-old woman with unstable Grave’s disease, who underwent thyroidectomy and developed persistent hyperthyroidism postoperatively. She was referred by an endocrinologist to a nuclear medicine outpatient clinic for RAI therapy. I-iodide scintigraphy revealed two foci with excessive tracer accumulation. One of the foci in the middle of the neck corresponded to the pyramidal lobe. Conclusion. The thyroid anatomy anomalies can lead to unnecessary implications for treatment. Identifying the pyramidal lobe preoperatively and removing it from patients requiring total thyroidectomy may decrease the recurrence rate of hyperthyroidism. Thyroid scintigraphy is a useful diagnostic tool to visualize the pyramidal lobe.
EN
Introduction and aim. Fabry disease (FD) is a ultrarare storage disorder which causes irreversible damage to the brain, heart, and kidneys in young patients. The aim of our study was to draw clinician’s attention to the need of considering FD in the differential diagnosis of kidney disorders. Description of the case. We present the case of a 45-year-old man who has been misdiagnosed for several years with arterial hypertension with organ complications. He was referred to the nephrological ward due to chronic advanced kidney disease of unclear etiology. After 2 months of thorough differential diagnostics, based on the clinical course (past stroke, membranoproliferative glomerulonephritis (MPGN), left ventricular hypertrophy, paroxysmal limb pain) and conducted genetic examination, FD was confirmed. Then, screening tests were performed among the patient’s family members, confirming the presence of the same mutation as in our patient in 4 women of which in 3 were diagnosed cardio-renal syndrome. The authors of other studies report glycolipid deposits in the kidney cells on a needle biopsy, usefulness assess podocyturia, globotriaosylceramide protein in the urine and renal parapelvic cysts in an ultrasound examination in diagnostic FD nephropathy. Conclusions. This is the first case report to describe membranoproliferative glomerulonephritis in a patient suffering from FD. In patients with FD and the same genotype, kidney damage has a different phenotype.
EN
Introduction and aim. Elderly patients with COVID-19 are at increased risk for adverse outcomes. This study aims to evaluate the prevalence of nonthyroidal illness syndrome (NTIS) in hospitalized patients with COVID-19 pneumonia, its independent impact on patients’ survival. Furthermore, to investigate selected inflammatory biomarkers in those patients and to determine whether they predict mortality associated with the disease. Material and methods. In this single-centered, retrospective study, the medical records of 53 patients with confirmed SARSCoV-2 infection who attended the provincial hospital between October 2020 and January 2021 were reviewed. Demographic data, laboratory values, comorbidities, treatments, and clinical outcomes were collected. We compared the data in survivor and non-survivor groups. Results. Of 393 adult patients with SARS-CoV-2 pneumonia, 53 (13,49%) met the inclusion criteria and were included. The median age was 72±12.2 years, 26 patients (49%) were men. The NTIS prevalence was 62.3% and showed a strong independent correlation with disease severity and mortality in COVID-19 patients (p=0.01). The interleukin-6, white blood cells, ferritin and neutrophil ratios also differed significantly statistically between survivors and non-survivors. Conclusion. NTIS and the lowering level of FT3 pose an independent prognostic marker of clinical deterioration and higher mortality in elderly patients with COVID-19.
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