A 63-year-old male with a history of 3 years diabetes mellitus is complaining of muscle cramps at the back of his left thigh while walking for last 3 days. He has a hstory for diabetes mellitus type 2 for past 3 years. He is not taking any medicines for his diabetes. On general examination, he has no anemia, jaundice, cyanosis. He has no hepatomegaly or splenomegaly. His BP is 135/85 mm Hg. Cardiac and respiratory examination is normal. On skin examination, he has reddish non-pruiritic, painless skin lesions over the anterior-lateral aspect of lower right thigh and right leg for the same duration. He never had these lesions before. (his skin lesions are attached below). His random blood glucose level is 9.1 mg/dl.
This 57 year olf lafy presented with neck swelling, anxiety and tremor. Her medical information is attached below: We need to take a decision on this lady. To operate or not to operate. Now that our clinical suspicions of thyroticosis have been proved and malignancy not proved (not disproved either) what would be the next best step? Medical management for her thyrotoxicosis or still get an excision biopsy with sub total thyroidectomy (and subtotal thyroidectomy other than disproving malignancy will also become treatment for her hyperthyroidism). So which one should we prefer (if the family has no reservations from their side)?
Glucagonoma, necrolytic migratory erythema.
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