A patient with PUO admitted for 19 days and yet no respite in his fever

A patient with PUO admitted with us for 19 days and yet no respite in his fever. [1] Recently detected diabetes, BPH, initially grew E Coli in small amount and later cultures sterile. The CT has been reported as bilateral centrilobular nodules of infective origin by our radiology department. [2] The LFT above is suggestive of dissemination although the transaminitis appears to be receding. [3,4] His Mantoux test was negative and this completes most of his work up here. A bone marrow is planned tomorrow for cultures, mtb, parasites and other infiltrates.

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57 Year Old female with goiter and thyrotoxicosis

This 57 year olf lafy presented with neck swelling, anxiety and tremor. Her medical information is attached below: We need to take a decision on this lady. To operate or not to operate. Now that our clinical suspicions of thyroticosis have been proved and malignancy not proved (not disproved either) what would be the next best step? Medical management for her thyrotoxicosis or still get an excision biopsy with sub total thyroidectomy (and subtotal thyroidectomy other than disproving malignancy will also become treatment for her hyperthyroidism). So which one should we prefer (if the family has no reservations from their side)?

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60 year old woman with hypothyroidism and SIADH

This patient is a 60 year old woman with recent vomiting, coma (sodium 107) and clinical features of dull apathy, skin coarsening, bradycardia, areflexia strongly suggesting hypothyroidism. Serum osmolality and urine sodium are suggesting SIADH. Thyroid profile: Our patient's current dose of sodium is 10ml per hour and she is having mild hypotension at times and in her blood sugar recordings hypoglycemia (attached below) was noted. In brain imaging, empty Sella is noted (attached below). Most of the data we have till now is suggesting hypopituitarism Online Discussion:

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