The skin changes seen on the lower legs are typical of Graves' dermopathy. The skin has a leathery texture, thickening and fissuring.
Graves' disease, named after the Irish doctor Robert James Graves, who first described it in 1835 is caused by an overactive thyroid gland. Thyroid auto-antibodies stimulate thyroid hormone synthesis and secretion and the thyroid gland grows into a goiter. (A goiter can occur with an overactive or underactive thyroid or even a normal functioning gland) The hyperthyroidism causes tremor, hyperactivity, heat intolerance, weight loss and insomnia. The eyes can bulge out and tear excessively and this is called Graves' ophthalmology.
Graves' disease is an auto-immune disorder and it is more common in women and in people with a family history of endocrine disorders. Treatment consists of inhibiting the production of thyroid hormones, either by radioactive iodine therapy to shut it off or surgery to remove the thyroid (thyroidectomy). Other drug treatments can block the effects of hyperthyroidism and interfere with the thyroid's use of iodine to produce hormones.
The patient in the Medical Challenge had his thyroid removed. When that happens, the patient takes thyroid replacement therapy forever.
You got it right, Solitary Diner. You are ready for board exams!