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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acquired reactive perforating collagenosis (ARPC) is an uncommon dermatosis characterized by transepidermal elimination of altered collagen. It is commonly seen in patients with diabetes mellitus and/or chronic renal insufficiency. Rarely, it has been reported in association with malignancy and other conditions. We report a 30-year-old woman with insulin-dependent diabetes mellitus who presented with multiple, discrete, violaceous, hyperkeratotic papules on the extensor aspects of both legs, characteristic of ARPC. Four months later, metastatic papillary thyroid cancer was diagnosed. This case further supports the possibility that ARPC may represent a paraneoplastic phenomenon.
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PMID:Acquired reactive perforating collagenosis associated with papillary thyroid carcinoma: a paraneoplastic phenomenon? 1943 50

Metastatic thyroid cancer is an uncommon condition to be present at the time of pregnancy, but presents a challenging paradigm of care. Clinicians must balance the competing interests of long-term maternal health, best achieved by iatrogenic hyperthyroidism, regular radioiodine therapy and avoidance of dietary iodine, against the priority to care for the developing foetus, with inevitable compromise. Additionally, epidemiological and cellular data support the role of oestrogen as a growth factor for benign and malignant thyrocytes, although communicating the magnitude of this risk to patients and caregivers, as well as the uncertain impact of any pregnancy on long-term prognosis, remains challenging. Evidence to support treatment decisions in this uncommon situation is presented in the context of a case of a pregnant teenager with known metastatic papillary thyroid cancer and recent radioiodine therapy.
Endocrinol Diabetes Metab Case Rep 2016
PMID:Management of metastatic thyroid cancer in pregnancy: risk and uncertainty. 2799 75

Purpose: Radioactive iodine therapy with 131I is standard of care for treatment for many patients with differentiated thyroid cancer. Typically, 131I is administered as a pill, and much of its radioactivity gets excreted via the urine. This can present challenges in patients who are unable to swallow pills, absorb iodine via the gastrointestinal tract, or eliminate radioiodine via the urine (i.e. dialysis patients and patients with renal failure). In this case series, we present three cases in which the standard 131I treatment protocol for thyroid cancer could not be executed due to these challenges, and discuss the strategies to overcome these challenges. Results: Case 1 was a 4-year-old male with Noonan syndrome, dysphagia, and metastatic papillary thyroid cancer. He was unable to swallow the standard 131I pill due to the dysphagia. After a multi-disciplinary discussion between healthcare staff, a joint decision was made to proceed with liquid 131I therapy. The system, which was used to orally administer 75 mCi (2775 MBq) of Na131I in a liquid form, involved a vial provided to allow for mixing in grape juice. Case 2 was a 45 year-old male patient with significant scleroderma, severe gastric motility disorder, and papillary thyroid carcinoma. His severe gastric motility and malabsorption disorder precluded oral treatment due to risks of vomiting. Per discussions and collaborations with the patient's gastroenterologist, the decision was made to proceed with intravenous 131I therapy, which was successfully performed after approval from the Radiological Health Branch of California. Case 3 was a 59 year-old male patient on hemodialysis with diabetes, hypertension, and follicular thyroid cancer. The challenge, in addition to waste disposal and dosimetry, was ensuring radiation protection for everyone present, given the risks of occupational exposures from radioactive iodine contaminating the dialysis machine. The radiation safety team monitored all healthcare workers and equipment involved, as per a joint decision by healthcare providers. Additionally, the planned dose was reduced from 50 mCi (1850 MBq) to 30 mCi (1110 MBq). None of the cases reported further disease progression since 131I treatment. Conclusion: These cases highlight unique challenges that can be encountered during radioactive iodine administration and approaches that can overcome these challenges. We conclude that provider collaboration and treatment customization are critical to overcome patient-specific challenges.
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PMID:Management of challenging radioiodine treatment protocols: a case series and review of the literature. 3321 59