Endocrine Abstracts

Grave’s disease is an autoimmune condition commonly presenting with symptoms of hyperthyroidism including weight loss, palpations and tremor; rarely, it presents more atypically.A 35-year-old male (non-smoker, no significant history) presented with an atraumatic femur fracture. He was incidentally noted to have a large goitre, tachycardia and mild proptosis but no symptoms of hyperthyroidism. Further bloodwork revealed iron deficiency, unremarkable tumour markers including LDH, PSA, AFP, CEA and CA19.9, and a negative myeloma screen. Computed tomography (CT) imaging confirmed a goitre and a distal femur fracture. Multiple small soft tissue densities were noted throughout the length of the femur reported as consistent with benign red marrow rests with no evidence of malignancy. Subsequent imaging included a DEXA revealing severe osteoporosis at the hip and spine (T score femur -2.9, spine -4.5) and chronic grade 1 vertebral insufficiency fractures; an unremarkable CT thorax, abdomen and pelvis and an isotope bone scan demonstrating no evidence of metastasis or other pathology. The fracture underwent surgical fixation. Hyperthyroidism is being treated with carbimazole and beta-blockers. Severe osteoporosis is being managed in the context of longstanding unrecognised hyperthyroidism. This is rarely reported in the literature, usually in the paediatric population; a pathological fracture is even rarer. Prolonged untreated hyperthyroidism can lead to severe osteoporosis and increased fracture risk in otherwise healthy adults. Grave’s disease should be considered in the differential in such scenarios.