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Case Overview

Total thyroidectomy of a 54 year old man with non-toxic MNG was done. After the right lobe was removed, a circular mass of bone like consistency was appreciated in the left lobe.

First photograph is post operative and shows the mass dissected from the lobe. 2nd photograph shows peroperative appearance of the mass.

Sample was sent for histopathology.

Query

What's the incidence of thyroid stones or calcifications?

Key Results

In the clinical study, authors investigated insulin stored for six weeks in an unglazed clay pot or in a refrigerator. Outside temperatures were between 34 °C and 43 °C, and clay pot temperatures were between 25 °C and 27 °C. The study authors only reported on the glucose level in the blood of eight healthy volunteers after injecting clay‐pot‐stored insulin or refrigerator‐stored insulin. Insulin in the clay pot had similar glucose‐lowering activity to insulin in a refrigerator.

Laboratory studies on prefilled syringes stored at 4 °C to 23 °C for up to 28 days showed no clinically relevant loss of insulin activity.

Nine laboratory studies examined unopened vials and cartridges. In studies with no clinically relevant loss of insulin activity, temperatures ranged between 28.9 °C and 37 °C for up to four months. Two studies reported a more pronounced loss of insulin activity after one week to 28 days at 37 °C. Four studies examined opened vials and cartridges at up to 37 °C for up to 12 weeks, and showed no clinically relevant reduction in insulin activity.

Two laboratory studies analysed storage conditions for shifting temperatures between 25 °C and 37 °C up to 12 weeks, resembling daytime and night‐time fluctuations in tropical countries. There was no loss of insulin activity for short‐acting, intermediate‐acting and mixed insulin.

Four laboratory studies, two on vials, one of them on opened vials, and two on prefilled syringes, investigated sterility and reported no bacterial contamination.

Four manufacturers provided previously unpublished temperature and storage conditions data. If unopened human insulin vials or cartridges were stored at up to 25 °C for a maximum of six months or at up to 37 °C for a maximum of two months, only small amounts of insulin activity were lost. We could not include the provided data from the manufacturer Sanofi because the company announced the permanent discontinuation of the production of human insulins called Insuman Rapid, Basal and Comb 25.

If no reliable refrigeration is possible, room temperature can be lowered using simple cooling devices such as clay pots for insulin storage.

There were no data for cold environmental conditions or insulin pumps.