Thursday, May 5, 2005

Stating the Obvious

In the hospital where I went to medical school, there was a bank. One of the tellers had Graves' disease. It was not subtle. All her findings were right out of the textbook: exophthalmos, a goiter, a slight tremor. For a year, every time I saw her, I thought "Hyperthyroidism and Graves' disease." Nearly every physician and student who came in there -- and there were hundreds -- must have thought the same thing.

A year later, she still didn't look well. I wondered why she wasn't improving with treatment. I mean, she must have been treated, right? On impulse, one day I asked, "Excuse me, do you have a thyroid disorder?" Her wide eyes widened even further and she said, "I was diagnosed last week. I was feeling terrible. I read about Graves' disease in a magazine and asked my doctor to test me."

This woman had gone an entire year with hundreds of people knowing her diagnosis and not telling her. I felt awful. Since then, I've been more inclined to speak up when I see someone with an obvious disease they might not know about. (This happens rarely.)

I was reminded of the bank teller's story by the "runaway bride." Jennifer Wilbanks also has goiter and exophthalmos, classic findings of Graves' disease. If she was hyperthyroid, this might also provide an explanation -- though not an excuse -- for her behavior. In the last week a handful of other people have suggested that she might have hyperthyroidism too.

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