Case of thyrotoxic periodic paralysis in a caucasian male and review of literature.

Objective. Thyrotoxic periodic paralysis (TPP), a known condition in Asian men, is becoming increasingly common in men from Western countries. Since suspicion for TPP as a differential in diagnosis is of utmost importance to avoid overcorrection of hypokalemia and other complications, we are reporting a case of TPP in a 25-year-old Caucasian male. Methods. The patient presented with intermittent lower extremity weakness after consumption of a large high-carbohydrate meal. Clinical examination revealed diffusely enlarged thyroid gland, no muscle power in lower extremities, tremors, and brisk deep tendon reflexes. Results. Clinical and laboratory findings were consistent with Graves' disease and the patient had hypokalemia. The patient responded to potassium repletion and was treated with propylthiouracil and propranolol. After treatment with radioactive iodine, the patient developed postablative hypothyroidism for which he was treated with levothyroxine. Conclusion. Since this condition is overlooked by physicians in Western countries, we present a case of TPP in a Caucasian male thus showing the importance of consideration of TPP in Caucasians despite its rare occurrence and the need for prompt diagnosis to avoid the danger of hyperkalemia in management of the paralytic attack in TPP patients.

Burkitt-like lymphoma arising in the thyroid gland.

INTRODUCTION: Primary Burkitt lymphoma of the thyroid gland is exceptionally rare. This highly aggressive, potentially curable malignancy arises from B cells. It presents as a rapidly expanding thyroid mass causing compressive symptoms. This article reports a very rare occurrence of Burkitt-like lymphoma in the thyroid, a variant of Burkitt lymphoma. METHODS: A 60-year-old white female developed a rapidly expanding thyroid mass associated with airway compression and difficulty in swallowing. RESULTS: Fine needle aspiration and cytometry studies established the diagnosis of lymphoma. The patient underwent an incisional neck biopsy which confirmed the final diagnosis according to the latest World Health Organization criteria. It was successfully treated with 1 cycle of appropriate therapeutic chemotherapy. CONCLUSION: In patients with lymphoma diagnosed on fine needle aspiration, an incisional thyroid and bone marrow biopsies are required to aid in the diagnosis and assure the appropriate chemotherapy protocol.

Time to recovery in diabetes and comorbidities following Hurricane Katrina.

BACKGROUND: The impact of a natural disaster on self-care and health care delivery has been well documented. The objective of the study was to document the recovery pattern from the impact of a natural disaster such as Hurricane Katrina on clinical and biochemical measures of diabetes and its comorbidities. METHODS: Patients were selected from Tulane University Hospital and Clinic, Southeast Louisiana Veterans Health Care System, and the Medical Center of Louisiana at New Orleans. Adults with diabetes and A(1c) measurement 6 months before (pre-K) Hurricane Katrina (February 28, 2005-August 27, 2005) and 6 to 16 months after (post-K) Katrina (March 1, 2006-December 31, 2006) were identified within the 3 facilities. Follow-up data (January 1, 2007-December 31, 2007) were 1 year after the first post-K visit. The outcome measures were hemoglobin A(1c) (HbA(1c)), systolic and diastolic blood pressure (BP), and lipids (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL], triglycerides). RESULTS: Averaged across the 3 facilities, the parameters significantly different in the follow-up period compared with pre- and post-K were HbA(1c) (P = .04), HDL, and systolic and diastolic BP (P < .0001). Parameters with significantly different patterns of change in the 3 facilities over time were HbA(1c), HDL, systolic and diastolic BP (P < .0001), and low-density lipoprotein (P < .01). CONCLUSIONS: Our results suggest that a variety of clinical and biochemical parameters related to diabetes and its comorbidities affected by natural disaster have varied the rate of recovery to predisaster levels.