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INTRODUCTION: Reduced circulating levels of 25(OH)VD are associated with an increased incidence of chronic lung diseases. Alpha-1-antitrypsin (AAT) is needed to maintain healthy lung function. OBJECTIVE: This study examined the hypothesis that circulating levels of AAT are lower in adult type 2 diabetic patients and that a positive association exists between circulating AAT levels and 25(OH)VD levels in these patients. METHODS: Fasting blood was obtained after written informed consent from type 2 diabetic patients (n=80) and normal siblings or volunteers (n=22) attending clinics at LSUHSC according to the protocol approved by the Institutional Review Board for Human studies. Plasma AAT and 25(OH)VD levels were determined using ELISA kits. HbA(1c) levels and chemistry profiles were analyzed at the clinical laboratory of LSUHSC hospital. RESULTS: ATT and 25(OH)VD levels were significantly lower in type 2 diabetic patients compared with those of age-matched healthy controls. There was a significant positive correlation between 25(OH)VD and ATT deficiency. AAT levels showed significant positive correlation with HDL cholesterol levels in type 2 diabetic patients. There was no correlation between AAT levels and those of HbA(1c) or with the duration of diabetes of T2D patients. CONCLUSIONS: These results suggest that 25(OH)VD deficiency may predispose type 2 diabetic patients to AAT deficiency. Whether reduced levels of circulating AAT indeed contribute to the increased risk for lung dysfunction in subjects with type 2 diabetes needs further investigation.

Background : Hypoparathyroidism is one of complication after thyroid, parathyroid, or radical neck dissection for head and neck cancer, which may be transient or permanent; or even intermittent. It can improve with improvement in PTH level gradually, otherwise continuous calcium and calcitriol supplementation is warranted to maintain calcium level. We present an interesting case of non PTH mediated post-surgical hypothyroidism resolution during pregnancy. Clinical Case: 22-year-old female presented to PCP with mass in her neck. Thyroid US revealed 3.3 cm left lobe nodule. Subsequent FNA of nodule showed Papillary thyroid carcinoma (PTC) and underwent total thyroidectomy with central and level 2-5 neck dissection. Pathology confirmed metastatic PTC (multifocal, sclerosing variant, largest 2.1 cm) with vascular invasion, 20/53 LN + with largest LN 0.8 x 0.5 cm. Post operatively she developed hypocalcemia with nadir corrected calcium (Cca) level of 7.2 mg/dl few days after surgery with undetectable PTH level. She had symptomatic hypocalcemia and needed high dose calcium and calcitriol replacement during hospitalization. She was discharged with elemental calcium 1000 mg TID, Vitamin D 200 IU TID, calcitriol 0.5 mcg daily and ergocalciferol 50000 units per week. She was supposed to receive radioactive iodine treatment after surgery, but it was held as she became pregnant. She was started on Levothyroxine. During follow up visit in 12 weeks of her gestation, she reported that she had stopped taking all her medications except levothyroxine for 1 month and reports no symptoms of hypocalcemia. Labs result showed Cca of 8.3 mg/dl, PTH again undetectable range, PTHrp 13 pg/ml (14 -27). she was advised to restart her medications and repeat Cca was 9.5 mg/dl, 25-OH Vitamin D 39.6 ng/ml and 1,25dihydroxy Vitamin D is 78.8 pg/ml (20-82), urine calcium-creatinine ratio 309 mg/gm. we stopped Calcitriol, ergocalciferol and continued with calcium/Vitamin D tablets. After stopping calcium, again calcitriol level was 78.6 pg/ml. she remained asymptomatic. Conclusion: Our case with post-surgical Hypoparathyroidism which resolved during pregnancy without improvement in PTH level is very rare and interesting. Literature review suggests that the placenta during pregnancy and breast tissues during lactation may produce PTHrP. But PTHrP in our case is low which excluding it as possible mechanism. There can be increased activity of 1 alpha hydroxylase by prolactin, estradiol and placental lactogen hormone which can increase calcitriol. It is in high normal level in our cases suggesting possible causes of resolution of hypocalcemia. We still need to monitor her for change in calcium level during her entire pregnancy which can affects her outcome. This case indicates we need to be vigilant and monitor calcium level closely during pregnancy.

Background: Anaplastic thyroid cancers are very rare accounting for 1-2% of thyroid cancer. It has been hypothesized that it may start from one of differentiated thyroid cancer up to 30% of cases but usually there will be evidence of differentiated thyroid cancer like PTC in thyroid. Here, we present a rare case of anaplastic thyroid carcinoma on thyroid gland with cervical lymph nodes also positive for papillary thyroid cancer with no evidence of PTC in thyroid gland. Clinical case: 54-year female with h/o primary hypothyroidism and thyroid mass for several years presented to ER with complaints of neck pain where CT scan showed large right thyroid mass with tracheal compression. She had noticed rapid growth of mass for last 1-2 months with some compressive symptom like neck pain and dysphagia. Later, FNA of right thyroid Mass showed atypical lymphoid cells in a background of Hashimoto's thyroiditis. PET scan showed Intense FDG uptake in right thyroid lobe, right supraclavicular LN and right level 2LN. Core biopsy of thyroid was performed which showed poorly differentiated neoplasm with spindle morphology and Immunohistochemistry result favor a thyroid undifferentiated neoplasm. She underwent Total thyroidectomy with neck dissection and final pathology showed large, 8 cm, anaplastic thyroid carcinoma with invasion into the strap muscle. 12/85 LN were positive for cancer among them 10 were PTC and 3 were anaplastic carcinoma. Due to large primary tumor being anaplastic it was decided against radioactive ablation and she was referred for external beam radiation. Thyroglobulin level was 2.8 (2.8 to 40.9 ng/ml) after 11 days from surgery with TSH 2.32 (0.35 - 3.74 iu/ml) and undetectable anti thyroglobulin antibody. She tolerated radiation treatment well and repeat Tg level had decreased to 0.1 ng/ml when checked 4 months after surgery with suppressed TSH. Conclusion: Anaplastic thyroid cancers are very aggressive, undifferentiated cancers with almost 100% fatality within 1 years. It is more common in female and occurs mostly after age 60 to 65. It is usually presented with rapidly enlarging mass. There can be h/o prior differentiated thyroid. Our case did not have evidence of primary PTC with in thyroid but at least 10/ 85 removed lymph nodes were positive for PTC which is unusual. Our case is rare and unusual due coexistence of PTC in LN without primary PTC and with large anaplastic tumor in thyroid. This case also teaches us if there is rapid growth of existence thyroid mass, we should watch for possible anaplastic thyroid cancer and should not delay biopsy.

Background: Resistance to thyroid hormone (RTH) is an inherited syndrome characterized by reduced responsiveness of target tissues to thyroid hormone. Incidence rate is about 1/40,000 live births [1]. RTH is due to defect in the thyroid hormone receptor, most common is being beta gene (THRB). It is not unusual to be confused with hyperthyroidism. We present a case of RTH with novel mutation which was wrongly managed by primary care provider (PCP) as hyperthyroidism. Case Presentation: 42 year old female was referred to Endocrine clinic by PCP for hyperthyroidism and thyroid nodule. She was initially presented to PCP with lethargy, constipation and neck pain. Ultrasound neck showed left thyroid nodule of 2 cm and lab tests showed TSH 3.14 uIU/ml (0.3-4.0), free T4 3.6 ng/dl (0.9-1.7) and free T3 5.3 pg/ml (2.1-4.4). She was started on Methimazole and propranolol. She had FNA of left thyroid nodule and was benign cytology. She stopped Methimazole after few months due to extreme lethargy and weight gain. Careful history in endocrine clinic explored that her mother had thyroid cancer, was evaluated in National Institute of Health (NIH) for abnormal thyroid hormones and was diagnosed with thyroid hormone resistance. Further testing on family revealed that she also had similar problem. She used to take cytomel several years ago and later stopped due to tachycardia. She had intermittent fatigue, constipation and palpitations. She had regular menstrual cycles, stable weight and no heat or cold intolerance. Pulse was 95 bpm. She had normal size thyroid gland, normal deep tendon reflexes and no tremors. Repeat lab tests showed TSH 4.60 uIU/ml (0.36-3.74), free T4 2.33 ng/dl (0.76-1.46), free T3 7.74 pg/ml (2.18 -3.98). Antibodies were TPO Ab 1.8, TSI < 89% (T (p.Leu454Phe). It was reported as a novel autosomal dominant missense variant in the THRB gene and was considered as pathogenic. Conclusion: Patients with RTH are usually asymptomatic even with high free T4 and free T3. TSH will be slightly high or normal due to failure to suppress hypothalamic-pituitary- thyroid axis. Most common clinical findings include goiter, hyperactivity and tachycardia.Tachycardia can present as heart predominantly expresses alpha isoform of the thyroid hormone receptor [2]. It may be mistaken with diagnosis of hyperthyroidism. Error in treatment with anti-thyroid agents or radioactive iodine ablation or thyroidectomy can be problematic. Reference 1. Lafranchi SH, Snyder DB, Sesser DE, et al. Follow up of newborns with elevated screening T4 concentrations. J Pediatr 2003; 143:296 2. Weiss RE, Murata Y, Cua K, et al. Thyroid hormone action in liver, heart and energy expenditure in thyroid hormone receptor beta deficient mice. Endocrinology 1998;139:4945

This study was carried out at National Maize Research Program, Rampur, Chitwan, Nepal to evaluate the effect of sowing dates on growth and grain yield of maize inbred lines. Seven maize inbred lines namely NML-2, RML-17, RML-32, RML-4, RML-86, RML-95 and RML-96 were planted on three different dates i.e. September 02, September 12, September 22, 2015 during winter using randomized complete block design with two replications. The results of this study showed that the growth and yield traits were significantly affected by various planting dates. The inbred line RML-17 produced the highest grain yield where as NML-2 gave the lowest yield during winter season. The highest yield was obtained when inbred lines were planted on September 12 and the lowest yield on September 2. The planting from September 2 to September 12 increased the grain yield. The delay in planting i.e. September 22 decreased grain yield. Therefore September 12 planting was suitable for inbred lines to maximize grain yield production.