Fluctuating body count in the diagnosis and management of an endocrine disorder
Hotspur | Opinion
Keen readers of The Endocrinologist may remember our occasional contributor, Hotspur. He has recently seen his last ever endocrine patient and sent us the story. We thank him for all his contributions and wish him well for the future…
Throughout medical history, numerous men and women are remembered for their great scientific and clinical contributions. Diseases were named after the early, if not earliest, observers, e.g. Cushing, Addison, Graves, etc., who reported specific conditions. Alas, this no longer occurs.
Personal success stories are still evident and in every Society for Endocrinology BES conference there are award lectures, in which individuals are honoured for their scientific/clinical contributions. It is clear from the content of these lectures, however, that a team effort is involved, when a lecturer finishes his/her talk with a slide listing the 10 or 15 individuals who contributed to the success of the work.
Professional fame within medicine is no longer feasible for a solitary individual. I mulled over this sad realisation, whilst in quiet retirement in an old mill in middle England. Curiously, it was here that I sensed a last chance might have come my way for a Hotspur symptom/sign to enter the medical literature. Medical is stretching it a bit, as my subject was a cat called Bruce, who belonged to one of the families that lived in the seven residences at the mill.
Bruce was an assassin who killed squirrels, voles, rats and young rabbits on a daily basis. Those executed were easy to count, as the bodies were deposited on the doorsteps of many of us who lived at the mill. The killing and showing off over the bodies were consistent and relentless. Even bank holidays were not recognised as days of rest. Therefore, when the killings ceased completely for several months, it was clear to me that something was up. It was then that I suddenly appreciated that my career would not be ending with a whimper, more like a meow. Here are my observations. Bruce had either lost the desire to kill, or ability to execute a kill, or both. Furthermore, Bruce was an old cat and looked a bit ragged. Epidemiologically, I knew that around 10% of elderly cats acquire some form of thyroid dysfunction. No-one else, to my knowledge, had put forward the suggestion that the desire and capacity to kill might be lost through the development of thyrotoxicosis. So Hotspur had made an original ‘clinical’ observation. Setting up human studies to challenge this hypothesis would take too long. Anyway, which known assassins would be likely to participate in a study in which the active arm might threaten their employment prospects?
My suggestion that Bruce have his thyroid function tests checked was quickly taken up by his owners and, to my delight, Bruce was thyrotoxic. Subsequently, he received anti-thyroid drug medication and, within months, put on weight and looked more energetic. His owners had his thyroid function tests checked regularly to determine if he was now euthyroid. I, of course, did not need to see the test results, as, reassuringly, the bodies were once again piling up on my doorstep. In truth I felt happy, not especially because of Bruce’s recovery, but because the newly described Hotspur’s symptom/sign had become an established fact, at least in this part of the world. Hotspur had achieved his personal fame, albeit by a whisker!