Background: Vitamin D is vital for human health but its deficiency is worldwide. There is a gap in our knowledge about vitamin D status in Bahrain. Objective: To identify vitamin D status and associated risk factors among men in Bahrain. Design: A cross-sectional study. Setting: Four public and four private maternity hospitals in Bahrain. Method: The study was carried out in the second and third weeks of April 2012. Three hundred sixty-four men (husbands of mothers who presented in labor) participated in the study. A questionnaire was administered and vitamin D level was measured in the blood. Bivariate and multiple linear regression analysis were used to evaluate differences between variables. P-value <0.05 was considered significant. Result: The mean age ± SD was 34.40 ± 7.27 years. Vitamin D mean level ± SD was 46.14 ± 12.80 nmol/L. Vitamin D level was <50 nmol/L in 233 (64%) men. The following variables showed significant association with vitamin D deficiency: high income (P-value 0.020), smoking (P-value 0.021), lack of sun exposure (P-value 0.001) and high body mass index (Pvalue 0.022). Conclusion: Vitamin D deficiency is common among men in Bahrain. High income, lack of sun exposure and high BMI were significant and independent predictors of low vitamin D level. There is a need for population-based study in a randomly selected sample which includes all age groups and both genders.

Primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum is a rare clinical condition. We present a 75-year-old male with primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum. This patient was initially referred to the clinic for suspected incidental hypercalcemia. Initial imaging showed two suspicious lesions: one adjacent to the thyroid gland and another in the mediastinum. Further investigations identified a sole mediastinal adenoma. The diagnosis was confirmed by normalization of parathyroid hormone levels after its surgical resection. Thoroughly diagnosing such cases can prove challenging and using a single modality such as ultrasonography, computed tomography, or nuclear imaging alone may not yield conclusive findings or can give false positive results. Our case demonstrates that a combination of several imaging modalities can lead to accurate localization of the cause of primary hyperparathyroidism. This will obviate the performance of unnecessary surgical procedures. In addition, the possibility of missing additional sources of ectopic secretions of the parathyroid hormone will be reduced.

Thyrotoxicosis complicated by advance degree atrioventricular block, a rare complication of a common disease. The term apathetic thyrotoxicosis, where palpitations and cardiac involvement are the sole manifestations of disease, is well known. Thyroxin's ability to sensitize the catecholamine receptors causing tachyarrhythmias is well addressed. However, as an aetiology for advanced heart block, thyrotoxicosis is ranked as one of the rarest.

Hyperthyroidism is a common disease. Thyroglossal duct cysts are also a very common type of congenital anomalies. Their co-existence is, however, rare with only a few cases described in the literature of the same. We describe the case of a 44-year-old female who presented initially 16 years ago with hyperthyroid symptoms related to Graves’ disease diagnosed serologically and by thyroid scan and ultrasound. Incidentally, she was also noted to have a non-complicated thyroglossal duct cyst. She was initially started on anti-thyroid medications but remained in a hyperthyroid state throughout most of her illness. Radioiodine ablative therapy and surgical resection were delayed due to the patient’s dispreference. After a long period of missed follow up, she presented with a thyroid storm and underwent a total thyroidectomy and cyst resection. The key endocrine issues learned from this case include: 1) dealing with non-compliant patients in terms of poorly controlled hyperthyroidism and refusal to follow the recommended treatment, 2) observing the natural disease progression of untreated Graves’ disease coexisting with a thyroglossal duct cyst, and 3) describing a rare incidental finding of a thyroglossal duct cyst coexisting with Graves' disease in the absence of ectopic hormone production. A few cases have described hyperthyroidism related to remnants of thyroid tissue in the thyroglossal duct or related to the thyroid gland. To the best of our knowledge, there are no cases reported of Graves’ disease coexisting with a non-complicated thyroglossal duct cyst making our case unique and first of its kind.

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