Delayed presentation of aggravation of thyrotoxicosis after radioactive iodine therapy at Graves disease / 영남의대학술지

Radioactive iodine (RAI) therapy is widely used for the treatment of Graves disease. After RAI therapy, 44% become hypothyroid and up to 28% remain hyperthyroid. The development of thyrotoxicosis after RAI therapy is believed to be mediated by 2 different mechanisms: a transient increased release of thyroid hormone due to radiation thyroiditis and the rare development of Graves disease due to the formation of antibodies to the thyroid-associated antigens released from the damaged follicular cells. A 55-year-old woman was hospitalized with severe headache, weight loss, and palpitation. She received a dose of 7 mCi of RAI (I-131) about 6 weeks earlier. Thyroid function test showed 7.98 ng/dL free T4, >8 ng/mL T3, <0.08 microIU/L thyroid stimulating hormone, and high titer thyroid stimulating immunoglobulin (TSI) (85.8 IU/L). She improved with propylthiouracil, propranolol, and steroid treatment. The TSI, however, was persistently elevated for 11 months.

Atypical Progression of Acute Renal Failure Associated with Cisplatin Chemotherapy / 대한내과학회지

Cisplatin is commonly used as chemotherapy for solid tumors. Its most important side effect is nephrotoxicity, which typically produces a gradual decline in renal function. Acute tubular necrosis is the usual pathological finding, while other findings are rare. A 75-year-old man presented to the emergency department (ED) with diarrhea and hypoglycemia. He was on 5-fluorouracil (5-FU)/cisplatin chemotherapy after a radical total gastrectomy for gastric cancer. Ten days earlier, he had been discharged after the third cycle of chemotherapy with normal renal function. When he arrived in the ED, he had azotemia (creatinine = 9.2 mg/dL) necessitating emergency hemodialysis. His renal function did not recover despite hydration and conservative treatment. Since he could not receive further chemotherapy due to the renal failure, he died 4 months later due to cancer progression. A renal biopsy performed 3 months after the renal failure showed acute tubular necrosis and severe interstitial fibrosis with normal glomeruli suggesting tubulointerstitial nephritis.