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Raised nodular lesions on patient's shins at presentation.

Nodular Thyroid Dermopathy: Not a Hallmark of Graves Disease

  A 40-year-old man presented to the outpatient department with complaints of multiple, nontender, raised nodular lesions on his shins bilaterally for the past year (Figure 1). The lesions had an insidious onset and were progressively increasing in size. He was evaluated at an outside clinic. Biopsy was performed multiple times, and possibility of spindle […]

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Chest radiograph at initial presentation. Cardiomegaly and moderate left pleural effusion noted.

Drugs, the Thyroid, and the Heart: A Lethal Cocktail

A 53-year-old man was referred for evaluation of a raised international normalized ratio blood result. He had been taking warfarin and amiodarone for 2 years following a transient episode of atrial fibrillation following a percutaneous coronary interventional procedure. He was receiving treatment for severe left ventricular systolic dysfunction and type 2 diabetes mellitus (Table 1). […]

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Hematoxylin-eosin stain showing patchy perivascular and interstitial granulomas (original magnification, 40×).

Sarcoidosis Presenting as Isolated Anasarca and Hypercalcemia

A 62-year-old woman presented to clinic for a second evaluation. Previously healthy, she initially presented for care several months earlier with anasarca. Initial workup was notable for normal renal function, calcium level, and liver function tests, no proteinuria, and echocardiogram demonstrating mild diastolic dysfunction and concentric left ventricular hypertrophy but preserved systolic function. One month […]

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Possible pathophysiology of thyrotoxicosis-induced vomiting.

A Grave Case of Vomiting

A 60-year-old woman presented with intractable nausea and vomiting, which had progressively intensified over the past 2 weeks. Her past medical history was remarkable for mild thrombocytopenia and mildly elevated liver enzymes. Her vomiting was triggered by oral intake, nonbloody and nonbilious, and associated with nonresolving epigastric pain, dysphagia, anorexia, and weight loss. She had […]

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Computed tomography of the head showing bilateral and symmetrical calcifications in basal ganglia in the axial image (A), and in the cerebellum and at the gray-white junction in the sagittal image (B).

Intracranial Calcification Due to Hypoparathyroidism

To the Editor: A 70-year-old Japanese man with a history of idiopathic hypoparathyroidism presented to the Emergency Department of our hospital owing to weakness in his right leg. Although his primary care doctor had prescribed activated vitamin D analogues, his serum calcium level was slightly low at 8.0 mg/dL. Owing to suspicions of stroke, he underwent […]

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Thyroid ultrasound demonstrated a large complex nodule measuring 6.6 × 4.5 × 3.3 cm with central internal blood flow that occupied almost the entire left thyroid lobe.

A Rarity in a Common Disease: Thyroid Paraganglioma

Thyroid nodule is extremely common in clinical practice. An evaluation of thyroid nodule is often straightforward. However, pathologic findings can occasionally be surprising. A 42-year-old previously healthy man was referred to the endocrinology clinic with asymptomatic neck enlargement noted during evaluation of acid reflux symptom. He had no previous radiation exposure to the head and […]

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