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Melissa Katz, Simon Smith, Luke Conway, and Ashim Sinha

empirical management is initiated in those at risk living in endemic areas. The case A 30-year-old Caucasian stay-at-home mother presented to our hospital in northern Australia with a 1-week history of undifferentiated abdominal pain and fevers. She

Open access

Shamil D Cooray and Duncan J Topliss

radiotherapy had good effect with resolution of the patient’s right flank pain and right lower limb numbness. Two months later, sorafenib received approval for use in Australia and was commenced at a dose of 200 mg po BD. Outcome and follow-up Two

Open access

Michael Dick, Sarah R Catford, Kavita Kumareswaran, Peter Shane Hamblin, and Duncan J Topliss

case. Our discussion encompasses alternate management strategies for chronic SIADH, in particular the role of demeclocycline. Case presentation A 32-year-old man was admitted to The Alfred Hospital, Melbourne, Australia in December 2010

Open access

Benjamin Kwan, Bernard Champion, Steven Boyages, Craig F Munns, Roderick Clifton-Bligh, Catherine Luxford, and Bronwyn Crawford

complications such as nephrocalcinosis, nephrolithiasis and renal impairment. We describe an Australian family with a novel heterozygous missense mutation causing ADH1. Case presentation A 40-year-old Caucasian woman presented with muscle spasms

Open access

Shivani Patel, Venessa Chin, and Jerry R Greenfield

placebo alone in patients with stage III, non-small-cell lung cancer (NSCLC) after definitive chemoradiation ( 4 ). In this study, new-onset diabetes occurred in one patient (<0.1%). In Australia, it is currently approved for use in both stage III NSCLC

Open access

Navira Samad and Ian Fraser

cancers has been shown to significantly reduce mortality (see reference – Cancer Council Australia). An excellent bowel preparation is critical for a colonoscopy ( 2 ) because it permits the visualization of the entire colonic mucosa and increases the

Open access

Caroline Bachmeier, Chirag Patel, Peter Kanowski, and Kunwarjit Sangla

a peripheral blood sample. SNP microarray was performed using the Illumina Whole-Genome InfiniumCytoSNP 850K Array v1.1. All procedures for fragmentation, labelling and hybridisation were performed at the Australian Genome Research Facility

Open access

Jane J Tellam, Ghusoon Abdulrasool, and Louise C H Ciin

://doi.org/10.1056/NEJM199204303261801 ) 9 Glendenning P . Diagnosis of primary hyperparathyroidism: controversies, practical issues and the need for Australian guidelines . Internal Medicine Journal 2003 33 598 – 603 . ( https://doi.org/10.1111/j

Open access

Alicia R Jones, Alan McNeil, Christopher Yates, Bala Krishnamurthy, and Peter S Hamblin

occipital meningioma removed at 17 years of age. He took no regular medications, was a non-smoker and consumed minimal alcohol. There was no personal or family history of connective tissue disorders or malignancy. He had migrated to Australia ten years

Open access

Kingsley Okolie, Daniel Chen, Raf Ghabrial, and Robert Schmidli

Summary

Multinodular goitre is not associated with eye disease, unless in a rare case of Marine–Lenhart syndrome where it coexists with Grave’s disease. Therefore, other causes of exophthalmos need to be ruled out when the eye disease is seen in a patient with multinodular goitre. Confusion can arise in patients with features suggestive of Graves’ ophthalmopathy in the absence of thyroid-stimulating hormone receptor autoantibodies and no evidence of other causes of exophthalmos. We present a case of multinodular goitre in a patient with exophthalmos which flared up after iodine contrast-based study. A 61-year-old Australian presented with a pre-syncopal attack and was diagnosed with toxic multinodular goitre. At the same time of investigations, to diagnose the possible cause of the pre-syncopal attack, computerised tomographic (CT) coronary artery angiogram was requested by a cardiologist. A few days after the iodine contrast-based imaging test was performed, he developed severe eye symptoms, with signs suggestive of Graves’ orbitopathy. MRI of the orbit revealed features of the disease. Although he had pre-existing eye symptoms, they were not classical of thyroid eye disease. He eventually had orbital decompressive surgery. This case poses a diagnostic dilemma of a possible Graves’ orbitopathy in a patient with multinodular goitre.

Learning points:

  • Graves’ orbitopathy can occur in a patient with normal autothyroid antibodies. The absence of the thyroid antibodies does not rule out the disease in all cases.
  • Graves’ orbitopathy can coexist with multinodular goitre.
  • Iodine-based compounds, in any form, can trigger severe symptoms, on the background of Graves’ eye disease.