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Russell D. Yang, MD, PhD; Joel Weissfeld, MD; Charles E. Putman, MD

JAMA. 1986;255(23):3275-3276.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

History

One week prior to hospitalization, a 78-year-old man experienced the insidious onset of anterior neck pain, sore throat, dysphagia, hoarseness, headache, and scalp pain. Generalized weakness, confusion, and an unsteady gait prompted his presentation. Prednisone (20 mg daily) had been prescribed three months earlier for refractory anemia without excessive normoblasts.

Physical examination on admission revealed a diaphoretic, toxic-appearing elderly man with a temperature of 39.6 °C, a pulse rate of 128 beats per minute, a respiratory rate of 34/min, and a blood pressure of 136/86 mm Hg. The patient resisted passive flexion of the neck. The thyroid gland was asymmetrically enlarged, with predominance of the right lobe, and was nonfluctuant and exquisitely tender. The teeth were severely carious. Hyperdynamic circulation and an apical systolic heart murmur were present. The patient had no splenomegaly or palpable lymphadenopathy. The remainder of the results of the physical examination were normal.

The findings . . . [Full Text PDF of this Article]

Author Affiliations
From the Departments of Medicine (Drs Yang, Weissfeld, and Putman) and Radiology (Dr Putman), Duke University Medical Center, Durham, NC.

Footnotes
Reprint requests to PO Box 3808, Department of Radiology, Duke University Medical Center, Durham, NC 27710 (Dr Putman).

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