Tauheed S, Naeem Ul Haque.
Unilateral Gynecomastia - An Unusual Presentation of Thyrotoxicosis.
J Pak Med Assoc Jan ;52(5):227-8.

A 52 year old man was referred for evaluation of gynaecomastia. He had history of a tender lump on the right breast and difficulty in walking for the past two months. He also complained of weight loss and disturbed sleep for the last three months. He was married and had three children and denied any sexual problems. On physical examination his weight was 54kg, pulse rate 96/minute and blood pressure 130/70 mmHg. Fine tremors of both hands were present and there was no proptosis and thyroid was not enlarged. Heart rate was 96/minute with no murmur or gallop. Examination of chest showed that the right breast had a 2 x 2 cm tender mobile lump under the areloa. Left breast was normal. He had difficulty in getting up from squatting position without support. Rest of the physical examination was unremarkable. Chest X-ray, complete blood count, fasting blood suguar and urine analysis at the time of presentation were within normal limits. He was advised to get his thyroid functions done which revealed free thyroxine (fro) 3.9 ng/dl (0.8-1.9), thyroid stimulating hormone (TSH) < 0.1uU/ML (0.40-4.0), serum sodium chloride and bicarbonate were within normal limits whereas serum potassium (K) was 3.6 mmol/L (3.8-5.2). He was prescribed Carbimazole 30 mg daily and propranolol 10 mg TID. On follow-up visit six weeks later, his physical examination revealed that his weight was 57 Kg, blood pressure 120/80 mmHg, pulse 72/minute and there were no tremors. He could easily get up from squatting position without support. The lump in the right breast had completely receded. His fT4 was 0.9 ng/dl and serum K was 3.9 mmol/L. TSH was still suppressed to < 0.1 uU/ml.

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