Graves’ Disease Presenting as a Unilateral Breast Mass

Introduction. Graves’ disease is an autoimmune thyroid disorder that is the most common cause of hyperthyroidism. Common manifestations of Graves’ disease include weight loss, palpitations, heat intolerance, fatigue, tremors, and exophthalmos, occurring in more than 50% of patients. In rare cases, findings may predominate in one organ system; isolated findings of diarrhea, anxiety, or gynecomastia (as in our case) may occur, distracting from the correct diagnosis. Case Report. We report on a 37-year-old male who presented to the primary care clinic with the chief complaint of a tender right-sided breast mass and with an associated loss of appetite and forty-pound weight loss. Laboratory evaluation revealed suppressed TSH and elevated free T4. A bilateral diagnostic mammogram revealed bilateral gynecomastia. A nuclear medicine thyroid uptake scan was subsequently ordered, which showed the diffusely enlarged thyroid gland with homogenous increased uptake throughout, consistent with Graves’ disease. Conclusion. It is important to keep a high index of suspicion for thyroid disease as hyperthyroid states may be deceiving in presenting with single organ system involvement. Although it is rare, gynecomastia is a known finding in Graves’ disease and can be the presenting sign. Patients with unexplained gynecomastia or breast masses should be screened for thyrotoxicosis

Lung Adenocarcinoma Presenting as Worsening of Chronic Neck Pain—A Cautionary Tale

Introduction: Neck pain is a common musculoskeletal problem that up to 70% of the world population will experience at some point in their lives. Intramedullary spinal cord metastasis is an exceedingly rare complication of malignancy that affects less than 1% of all patients with cancer. Case report: We report a case of a 61-year-old man who presented to primary care clinic with 1-month history of worsening neck pain with associated neurologic deficits. Despite initial conservative management, the patient continued to have progressive worsening of sensory and motor deficits. Magnetic resonance imaging of the cervical spine showed vasogenic edema of the brain and spinal cord and nodularity at the C4-C5 level. A computed tomography of the chest showed a dense lesion in the left lower lobe of the lung; histopathology of the biopsied specimen was consistent with moderately differentiated lung adenocarcinoma. Conclusions: A high index of suspicion is necessary when chronic neck pain acutely worsens, changes in character, or is accompanied by neurologic deficits. These clinical signs warrant further investigation into a secondary cause of neck pain. Intramedullary spinal cord metastases are rare complications of systemic cancer that commonly present with neck pain and upper extremity paraesthesias; early diagnosis and management are necessary to prevent complications such as spinal cord hemisection syndrome or spinal cord transection