BACKGROUND: Squamous cell carcinoma (SCC) of the thyroid is a rare condition comprising less than 1% of all thyroid malignancies. Thyroid SCC is a variant of undifferentiated thyroid carcinoma and is also associated with the tall-cell variant of papillary thyroid carcinoma (PTC) and spindle cell carcinoma. Given its aggressive clinical course, early recognition of the disease is essential to management. CASE: We report a rare case of a 67-year-old, Filipino male initially presenting with an anterior neck mass over a period of 11 months. This was accompanied by compressive symptoms, anorexia, and easy fatigability. He underwent total thyroidectomy with histopathology consistent with diffuse sclerosing variant of PTC with squamous differentiation. The patient had rapid tumor growth, tumor recurrence, nodal metastasis, and invasion of local structures within a year after his initial presentation. He underwent completion thyroidectomy and selective neck dissection and concurrent chemo-radiotherapy with a course of radiation (60 Gy in 33 fractions) and chemotherapy with Carboplatin and Paclitaxel. After 13 months of initial presentation, the patient eventually succumbed to cardiac arrest. CONCLUSION This transformation of the thyroid is an aggressive malignancy with increased mortality; hence it should be considered in cases presenting with progressive clinical behavior. Due to his aggressive disease, the patient’s nutritional status, airway protection, and immunity were compromised. A combined modality with surgery, radiotherapy, and chemotherapy to prevent disease progression may be needed due to its aggressive clinical course.

Background: Although elevated glucose levels are associated with adverse outcomes in the critically ill, HbA1c-based adjusted glycemic variables have not been extensively utilized as a tool to evaluate patients in the acute critical condition. Objective: This study aims to determine whether glycemic gap can predict adverse outcomes in patients with type 2 diabetes diagnosed with COVID-19. Methodology: A single center and retrospective study of adult patients with type 2 diabetes diagnosed with COVID- 19. Glycemic gap was calculated as the difference between the admission blood glucose and A1c‐derived average glucose. Logistic regression was used to determine association of glycemic gap and several adverse clinical outcomes. A decision curve analysis was used to determine the clinical utility of a clinical decision model based on this cut-off. Results: A total of 150 diabetic patients with COVID-19 were analyzed. Median baseline HbA1c was 7.5% (range 4.79–18.42), while median admitting blood glucose was 196 (range 71–506) mg/dL. From these, computed glycemic gaps ranged from -180.5 to 312.8 mg/dL, with a median of 13.75 mg/dL. On univariate analysis, for every unit increase in glycemic gap, odds of developing ARDS increased five times (cOR 4.798, 95% CI 2.08 to 11.09); odds of developing shock increased four times (cOR 4.48, 95% CI 1.48 to 13.44). No single cut-off value for glycemic gap was able to discriminate patients with favorable outcome from those with adverse outcome. The decision curve analysis graphically shows that glycemic gap has a positive net benefit for threshold risk of 50% or higher. Conclusion Higher glycemic gaps were significantly associated with increased risk for poor outcomes in diabetic patients with COVID-19. Glycemic gap should be correlated with clinical status and other laboratory parameters to make it a more powerful discriminant among COVID-19 infected patients.
Diabetes Mellitus, Type 2 ; COVID-19