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Explore the art of health deduction with medically illustrated cases by Dr Ciléin Kearns

Spot diagnosis: hyperthyroidism

Spot diagnosis: hyperthyroidism

A summary of the pattern of clinical signs in hyperthyroidism (eg Grave’s disease).

This is another medical illustration in my ‘medical mentalism’ series, which is about kindling the art of ‘cold reading’ health information, to be able to 'read' health at a glance.

Some key features:

Exophthalmos (aka proptosis): the eye is pushed forward in the orbit by soft tissue inflammation behind it, giving the appearance of enlargement. This inflamed soft tissue is mostly fat and can include the extraocular muscles, which can lead to pain on eye movement. Swelling of these muscles can lead to double vision as the different muscles may be affected to different degrees and track worse. The eyelids cover less of the sclera (whites of the eye), giving the appearance of a hard stare, and making it more difficult to keep the eye lubricated, which leads to dryness and irritation.

Accelerated metabolism: the thyroid basically regulates your metabolism, and so ‘hyper’ thyroid symptoms are explained by an accelerated metabolic rate. Faster metabolism means releasing more energy (leading to agitation, poor sleep), generating more heat (excess sweating, flushing), an increased appetite to sustain this (and weight loss as this is difficult to maintain), diarrhoea (faster transit), tremor, and so on..

Psychological symptoms: anxiety, emotional lability (mood swings), and depression, appear to be multifactorial commonly reported symptoms. They occur above levels expected for a chronic illness in the case of Grave’s disease, and appear to correlate with duration and severity of disease, but not with thyroid function or antibody levels. A persons appearance may change a lot, and permanently, in the course of illness (eg finger clubbing if this occurs), and so it is not difficult to empathise with some of these feelings.

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5 signs of a base of skull fracture

5 signs of a base of skull fracture

Formication (note the 'm')

Formication (note the 'm')