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Nicola Tufton, Nazhri Hashim, Candy Sze, and Mona Waterhouse

room with i.v. fluids, PTU 200 mg four times per day, propanolol 10 mg three times per day, prednisolone 30 mg once daily and regular paracetamol. Attempts were made to up titrate her β blockade, but she did not tolerate higher doses due to symptomatic

Open access

Punith Kempegowda, Lauren Quinn, Lisa Shepherd, Samina Kauser, Briony Johnson, Alex Lawson, and Andrew Bates

obtaining a further detailed history, the patient admitted to taking a CAM for chronic osteoarthritic knee pain ( Fig. 1 ). Toxicological analysis of the preparation revealed the presence of dexamethasone, ciprofloxacin, paracetamol, diclofenac, ibuprofen

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Soham Mukherjee, Anuradha Aggarwal, Ashu Rastogi, Anil Bhansali, Mahesh Prakash, Kim Vaiphei, and Pinaki Dutta

diagnosed to have DMN and was treated conservatively with paracetamol and tramadol with complete recovery within 6 weeks. The dose of levothyroxine was also optimized. Figure 1 (a) Swelling of the right calf muscle. (b) T2W fat-saturated MRI right leg

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Marlene Tarvainen, Satu Mäkelä, Jukka Mustonen, and Pia Jaatinen

output was 3700 mL in the polyuric phase. The mild headache was cured by paracetamol and the visual disturbances soon subsided. The patient was discharged 14 days after admission. Investigations The diagnosis of NE was verified by high levels of

Open access

Junji Kawashima, Hideaki Naoe, Yutaka Sasaki, and Eiichi Araki

Summary

Anti-tumor necrosis factor (TNF)-α therapy is established as a new standard for the treatment of various autoimmune inflammatory diseases. We report the first case showing subacute thyroiditis-like symptoms with an amyloid goiter after anti-TNF-α therapy. A 56-year-old man with Crohn's disease presented with fever and a diffuse, tender goiter. To control the diarrhea, anti-TNF therapy (infliximab) was administered 4 weeks before the thyroid symptoms emerged. The patient reported a swollen neck with tenderness on the right side and fever 4 days after the second infliximab injection. An elevated serum C-reactive protein (CRP) and serum thyroid hormone level with suppressed serum thyrotropin were observed. The thyroid-stimulating antibody was not elevated. An ultrasonograph of the thyroid revealed an enlarged goiter with posterior echogenicity attenuation and a low echoic region that was tender. The thyroid uptake value on technetium-99m scintigraphy was near the lower limit of the normal range. The patient was initially diagnosed with thyrotoxicosis resulting from subacute thyroiditis. Administration of oral prednisolone improved the fever, thyroid pain, and thyroid function, but his thyroid remained swollen. The patient developed diarrhea after prednisolone withdrawal; therefore, adalimumab, another TNF inhibitor, was administered. After three injections, his abdominal symptoms were alleviated, but the thyroid pain and fever recurred. Elevated serum CRP levels in the absence of thyroid dysfunction were observed. The patient's symptoms resolved after prednisolone retreatment, but an elastic, firm goiter persisted. A fine-needle biopsy revealed amyloid deposition in the thyroid.

Learning points

  • Many cases with thyroid dysfunction accompanied by amyloid goiter have been reported.

  • There are cases that develop amyloid goiter with subacute thyroiditis-like symptoms after anti-TNF therapy.

  • When the thyroid remains swollen after improvement of thyrotoxicosis following treatment with prednisolone, it should be assessed to differentiate between an amyloid goiter and common subacute thyroiditis.

Open access

Caterina Policola, Victoria Stokes, Niki Karavitaki, and Ashley Grossman

readmitted for further treatment of his hip. He had discontinued taking opiate analgesics at least 2 months earlier and was taking only hydrocortisone and paracetamol. Pituitary function was re-checked before he took his morning dose of hydrocortisone. He

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Mona Abouzaid, Ahmed Al-Sharefi, Satish Artham, Ibrahim Masri, Ajay Kotagiri, and Ashwin Joshi

, paracetamol and donepezil. He had no personal history of kidney stones or any fractures. His endocrine evaluation confirmed the diagnosis of biochemical PHPT ( Fig. 1 ) with subsequent localisation of a 7 × 6 mm left inferior parathyroid adenoma by

Open access

S Hussain, S Keat, and S V Gelding

and TSH were normal. Paracetamol and salicylate levels were undetectable, and she tested negative for HIV. Table 1 A table summarising the patient’s blood results, at presentation, with normal laboratory reference ranges. Laboratory

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Rossella Mazzilli, Michele Delfino, Jlenia Elia, Francesco Benedetti, Laura Alesi, Luciana Chessa, and Fernando Mazzilli

) for a more serious respiratory bacterial infection (severely elevated C-reactive protein, leukocytosis and high fever). He was successfully treated with antibiotics and paracetamol, which normalised all infection parameters. In particular, his clinical

Open access

Farooq Khan and Mary Jane Brassill

-stimulating hormone (TSH) 0.135 mIU/L and free thyroxine (T4) 21.5 pmol/L). Her symptoms had resolved over a couple of days with oral paracetamol and ibuprofen. The patient also had a history of asymptomatic COVID-19 infection 3 months prior to her first vaccine dose