A 27-Year-Old Woman With White Spots on Her Face

Miriam Kinai, MB ChB


September 14, 2018

Physical Examination and Workup

Upon physical examination, the patient is a thin, young female. Her vital signs include a blood pressure of 110/70 mm Hg, a respiratory rate of 16 breaths/min, and a temperature of 98.6°F (37°C). Her pulse has a regular rhythm with a rate of 110 beats/min. Several sharply demarcated, depigmented, nonscaly, nonerythematous macules and patches are observed above her left eyebrow in a linear distribution. They appear chalky white when examined using a Wood's lamp.

The patient’s eyebrows and eyelashes are intact but grey-white in color. She also has premature graying of her hair, but no alopecia or other skin lesions are detected. Her lungs are clear on auscultation and the S1 and S2 hearts sounds are normal. Her thyroid is not enlarged and no thyroid bruit is noted. Her central nervous system examination findings are normal.

Laboratory investigations reveal a normal complete blood cell count as well as a normal basic metabolic panel. Her total thyroxine (total T4) is within normal limits at 10.0 µg/dL (reference range, 4.5-12.3 µg/dL) as is her triiodothyronine (total T3) at 160 ng/dL (reference range, 60-181 ng/dL). An ultrasound of her thyroid reveals an enlarged gland with decreased echogenicity.


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