Differential Diagnosis for 59-year-old Male with HTN, Thyroid Disease, Bone Pain, Edema on MRI, and Elevated Calcium

• Single Most Likely Diagnosis
  • Hyperparathyroidism: This condition is characterized by an overproduction of parathyroid hormone (PTH), which can lead to elevated calcium levels, bone pain, and edema. The patient's one-time finding of elevated calcium in the comprehensive metabolic panel (CMP) and history of thyroid disease (which may be related to parathyroid disease) make this a strong consideration.
• Other Likely Diagnoses
  • Metabolic Bone Disease (e.g., osteoporosis, osteomalacia): These conditions can cause bone pain and edema, especially in the context of thyroid disease, which can affect bone metabolism. Hypertension (HTN) may also contribute to bone health issues indirectly.
  • Thyroid-Related Bone Disease: Certain thyroid conditions, especially hyperthyroidism, can lead to bone resorption and pain. The patient's history of thyroid disease makes this a plausible diagnosis.
  • Paget's Disease of Bone: This condition involves the breakdown and regrowth of bone tissue, leading to bone pain and deformities. While less common, it could explain the patient's symptoms, especially if the elevated calcium level was a transient finding.
• Do Not Miss Diagnoses
  • Multiple Myeloma: A type of blood cancer that can cause bone pain, edema, and elevated calcium levels due to bone destruction. Although less likely, missing this diagnosis could be fatal, making it crucial to consider and rule out.
  • Metastatic Bone Disease: Cancer that has spread to the bones can cause pain, edema, and elevated calcium levels. Given the potential severity of this condition, it must be considered, even if the patient does not have a known primary cancer.
• Rare Diagnoses
  • Familial Hypocalciuric Hypercalcemia (FHH): A rare genetic disorder that leads to elevated calcium levels but is typically benign. It's less likely given the patient's symptoms but could be considered if other diagnoses are ruled out.
  • Sarcoidosis: A condition that can cause elevated calcium levels and bone pain due to granulomatous disease affecting various organs, including bones. It's rare but should be considered if other tests and diagnoses do not explain the patient's symptoms.