Classical hypothyroidism in a portrait by Jordaens

Montes Santiago, Julio

doi:10.1016/j.medcle.2017.05.014

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Detail of eyebrows, neck and hands. National Gallery, London. (Photos courtesy of Y. Carbajales)." ] ] ] "textoCompleto" => "Upon entering room 29 of the National Gallery in London, your attention is immediately drawn to a portrait by Jacob Jordaens, in principle due to its great dimensions (2.13×1.89mts).<a class="elsevierStyleCrossRef" href="#bib0035">1</a> It is the probable portrait–painted circa 1638–of Govaert van Surpele (1593–1674), then president of the Court in the city of Dieste, Brabant region (Belgium). He is accompanied by his second wife, Catharinna Connick, whom he had married after being a widower for 7 years. He stands, haughty, holding the staff of office, staring at us. She also looks at us and sits like a proud matron, wearing a black silk dress. But after the first glance, its morbid obesity is striking. Given that Jordaens, although meticulous in the portrait, would seek a favourable look for his clients, the prolixity of such feature is surprising. Although, other details emerge when we look closer at such a figure. Oedema in the fingers and arms, evidenced in the faint ridges marked by the bracelets; the discreet but significant goitre-or alternatively “double chin” of obesity, which the white ruffle cannot hide-; and loss of the tail of the eyebrows (Hertoghe's sign) make a diagnosis of hypothyroidism highly probable (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The absence of eyebrows does not seem a fashion because neither in the women of his other paintings at the National Gallery -2 “Sacred Families”- nor in the rest of his work does such a sign appear. Not even in the woman with evident goitre in El Prado's painting known as The Offering to Ceres.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Portraits with goitre – and cretinism – are relatively frequent in art, from Egypt to the Renaissance and Baroque, and appear in artists such as Van der Weyden, Dürer, Leonardo, Raphael, or Michelangelo. This one even reveals in a sonnet that suffers from goitre and seemingly appears with this process in a self-portray drawing at the foot of the poem. Nearly 41% of the characters appear to have goitre in portraits of well-to-do families from Bern (Switzerland), a region with high endemism due to iodine deficiency.<a class="elsevierStyleCrossRef" href="#bib0040">2</a> However, there appear to be no references to other dermal signs of hypothyroidism.Jacob Jordaens, was born and died in Antwerp (1593–1678), began as a tapestry artist, but later, in addition to engraving, he painted biblical and mythological themes, followed by portraits and customs of Flemish life.<a class="elsevierStyleCrossRefs" href="#bib0035">1,3</a> His best-known paintings have to do with the exaltation of popular joy, and in them, he often incorporates his teacher and father-in-law, Adam van Noort, as a model (versions of the Old Sing so the Young Twitter or The King Drinks). Under the tutelage of Rubens, he participated in the decoration of Antwerp when Cardinal-Infante Don Fernando (1635) started his governorate of the Spanish Flanders. After the death of Rubens (1640) he became the most famous Flemish painter; being commissioned to finish several of his works, including the paintings of the Tower of the Parade for the Spanish Court, and received orders from other royal courts, such as the Dutch of Orange, the Swedish or the English.But apart from his artistic production, Jordaens is interesting for other reasons related to Medicine and Art. One, already noted, is for having replaced Rubens due to his persistent gout, deforming arthritis and death at 62 years of age. Also, because it seems to be, together with Rubens, one of the first painters to reflect the initial stages of rheumatoid arthritis (RA) in his work. Indeed, in the excellent portrait of his own family, preserved in El Prado -he, his wife Catherine and his daughter Elizabeth, 1622-, various experts report that the servant who appears between the married couple has bilateral inflammation of metacarpal and interphalangeal joints, indicative of RA.<a class="elsevierStyleCrossRefs" href="#bib0050">4,5</a>And, finally, Jordaens, his daughter Elizabeth, who lived with him and, previously, other famous artists like Quentin Metsys, died in October 1678, in just 24h, due to a mysterious disease (Zweetziekte or Polderkoorts in Dutch, meaning “sweaty, feverish disease”) which appeared in Antwerp, Amsterdam and Ghent, apparently coming from England, which suddenly disappeared at the end of the year. It was attributed to typhus fever,<a class="elsevierStyleCrossRefs" href="#bib0035">1,4</a> but recent research point to a possible hantavirus.<a class="elsevierStyleCrossRef" href="#bib0060">6</a>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Montes Santiago J. Hipotiroidismo clásico en un retrato de Jordaens. Med Clin (Barc). 2017;148:573–574." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2889 "Ancho" => 3400 "Tamanyo" => 861276 ] ] "descripcion" => array:1 [ "en" => "Portrait of Govaert van Surpele and his wife, by Jacob Jordaens (1638). Detail of eyebrows, neck and hands. National Gallery, London. (Photos courtesy of Y. Carbajales)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "The National Gallery. Portrait of Govaert van Surpele (?) and his wife, 1636–8, Jacob Jordaens [consulted 3 Jan 2017]. Available in: <a href="http://www.nationalgallery.org.uk/paintings/jacob-jordaens-portrait-of-govaert-van-surpele-and-his-wife">www.nationalgallery.org.uk/paintings/jacob-jordaens-portrait-of-govaert-van-surpele-and-his-wife</a>" ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Museo del Prado. Jordaens, Jacob [consulted 3 Jan 2017]. Available in: <a href="http://www.museodelprado.es/aprende/enciclopedia/voz/jordaensjacob/fa4c61814ccd471caf5f2fd081e8cfbd">www.museodelprado.es/aprende/enciclopedia/voz/jordaensjacob/fa4c61814ccd471caf5f2fd081e8cfbd</a>" ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Sena LM. Thyroid in art. Communication at the Annual Meeting of the American Society for Clinical Pathology, October 2011. Las Vegas, NV [consulted 3 Jan 2017]. Available in: <a href="http://dn3g20un7godm.cloudfront.net/2011/AM11SA/161.pdf">http://dn3g20un7godm.cloudfront.net/2011/AM11SA/161.pdf</a>" ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Una visita médica al Museo del Prado" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Castillo Ojugas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "1998" "paginaInicial" => "87" "paginaFinal" => "101" "editorial" => "You & Us" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The artist and the physician. Another perspective in paintings (translated by A. McDonald)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Dequeker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2010" "paginaInicial" => "14" "paginaFinal" => "15" "editorial" => "Davidsfonds" "editorialLocalizacion" => "Leuven" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Were the English sweating sickness and the picardy sweat caused by hantaviruses?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Heyman" 1 => "L. Simons" 2 => "C. Cochez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/v6010151" "Revista" => array:6 [ "tituloSerie" => "Viruses" "fecha" => "2014" "volumen" => "6" "paginaInicial" => "151" "paginaFinal" => "171" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24402305" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014800000012/v1_201707060050/S2387020617303674/v1_201707060050/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014800000012/v1_201707060050/S2387020617303674/v1_201707060050/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303674?idApp=UINPBA00004N"]

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Vol. 148. Issue 12.

Pages 573-574 (June 2017)

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