June 29, 2018

This Photoclinic article was published originally in the September 1990 issue of Consultant

Read the Editorial based on this article, written by Consultant Board Member XXX here.


Thampi Verghese, MD

Verghese T. Hypothyroidism. Consultant. 1990



This 60-year-old man, taking doses of vitamin B12 his doctor had prescribed for treatment of pernicious anemia, felt tired and developed alopecia. After several months he came to the office of Dr Thampi Verghese, of Ware, Mass, complaining of sleepiness, tiredness, and hoarseness. He was unable to go to work. He was pale, bald, and myxedematous (Figure 1).

hypothyroidism figure 1

Diagnostic tests included free thyroxine index (FTI), 0.2 (normal range 2.2 to 4.7) and thyroid stimulating hormone (TSH), >75.2 (05.4-10). He was started on levothyroxine, 100 XXXg/d, and this same dosage was continued throughout therapy.

The patient’s condition improved, and after 5 months his TSH had dropped to 10.0 in one month and later to 4.2 in another month. He grew a full head of hair (Figure 2) and was able to return to work. He continued to take B12, and the pernicious anemia was also brought under control.

hypothyroidism figure 2

Hypothyroidism occurs in association with pernicious anemia and diabetes mellitus. The diagnosis in this case was clinically obvious because of the advanced state. The photo before treatment was taken in December 1986 and the photo after treatment was made in July 1987.