Gynaecomastia as the initial presentation of thyrotoxicosis
A 35-year-old Indian male, presented in our outpatient department with a complain of bilateral painful breast enlargement for 1 month. On further questioning, a history of weakness, weight loss, and excessive eating were revealed. The patient was married and had two children. He had no addiction, no history of any drug therapy, recently developed insomnia, anxiety, decreased libido, but no erectile dysfunction. On physical examination, he was mildly anemic, thin built (BMI-18 kg/m2) with a just palpable thyroid. His resting pulse rate was 122/m, and he had fine-tremor in his hands. He was normotensive. No orbitopathy or dermopathy detected. He had bilateral tender gyncecomastia (disc diameter 2.5 cm). His deep tendon reflexes were brisk. He was a well-virillised men with prominent adamisapple, pubic hair of tanner stage 5, stretched penile length of 12 cm and testicular volume of 20 ml bilaterally.\nHis laboratory investigation revealed normal haemogram, fasting plasma glucose: 101 mg/dl, 2-h PP plasma glucose: 167 mg/dl, normal renal and liver function tests, FT4: 3.9 mg/dl (normal 0.58-1.64 mg/dl), FT3: 8.3 pg/ml (normal 2.39-6.79 pg/ml), HS-TSH (3rd gen.): 0.03 mIU/ml (normal 0.34-3.50 miu/ml). Testosterone (total): >1600 mg/dl (normal 250-1600 mg/dl) Beta human chorionic gonadotropin (HCG): 2 miu/ml (<5 Miu/ml), Estradiol 95 mg/l (normal <50 mg/l), sex hormone binding globulin (SHBG): 132 nmol/l (normal 7-50 nmgl/l) luteinizing hormone (LH) 19.7 mlu/ml (normal 0.8-7.6 mlu/ml) follicle stimulating hormone (FSH) 8.06 mlu/ml (normal 0.7-11.1 miu/ml), Prolacton 10.4 mg/dl (normal 2.5-17 mg/ml). Imaging studies like ultrasonography (USG) abdomen and st. X-ray chest failed to defect any abnormality.\nBased on these reports a provisional diagnosis of thyrotosicosis with gynaceomastia was made and given a treatment with carbinazole and propranoloe.