Mona Lisa is euthyroid: a modern-day diagnosis

Leonardo da Vinci was born in Italy. Among the researchers and scientists, he is favourably known for his remarkable efforts in scientific work. His investigations of atherosclerosis judiciously combine three separate fields of research. In 1506, he finished his masterpiece, painting of Mona Lisa. A careful clinical examination of the famous painting reveals a yellow irregular leather-like spot at the inner end of the left upper eyelid and a soft bumpy well-defined swelling of the dorsum of the right hand beneath the index finger about 3 cm long. This is probably the first case of familial hypercholesterolemia (FH). The FH code of Leonardo da Vinci was given immense consideration by scientists like Carl Muller, who described the xanthomas tuberosum and angina pectoris. On the contrary, Akira Endo searched for microbial metabolites that would inhibit HMG-CoA reductase, the rate-limiting enzyme in the synthesis of cholesterol and finally, Michael Brown and Joseph Goldstein published a remarkable series of elegant and insightful papers in the 70s and 80s. They established that the cellular uptake of low-density lipoprotein (LDL) essentially requires the LDL receptor. In conclusion: this was the real Code of Leonardo da Vinci.

Sir, Goiter, similarly to numerous modern diseases, appears in Ancient Greek art and thus raises the question whether it represented what is currently called Grave's disease. Three clay figurines have been discovered representing this pathological condition. The earliest archeological finding is a Minoan figurine found in the Peak Sanctuary of Traostalos, dated at the end of the 3rd millennium BC. This figurine, a votive offering depicting a male head, was carved with a very large goiter in its neck.[1] The second example [Figure 1] is a figurine, dated at the late Hellenistic or the early Roman age, found in Smyrna (Leiden, Rijksmuseum van Oudheden: S 186), also representing a male head with a large goiter on its neck.[2] The third example [Figure 2] is a figurine of a female head, found in Troy and dated in the 1st century BC (Paris, Louvre: D 556). This third figurine presents not only with a large goiter in its neck, but also an apparent bulging of the eyes (Greek: εξώϕθαλμoς, exophtalmos), raising the hypothesis that these are representations of Grave's disease.[3 4] While the first figurine was a votive head, the other two represent realistic portraitures of the era. Some researchers believe that goiter also appears on portrait representations on Ancient Greek coins.[5] We, on the contrary, believe that a protuberance in the neck in a coin represents most probably a sing of dynamism of the represented person. It is rather unlikely that a distinguished personality such as a king, a general, or any form of hero, would have allowed to be “immortalized” as an ill figure. An alternative interpretation could be this of artistic miss-representations arising from the difficulty of handling the given material and the small surface on which the artist had to work. As always Ancient Greek art provides detailed realistic representations of various conditions. Figure 1 Male figurine, dated at the late Hellenistic or the early Roman age, found in Smyrna Figure 2 Female figurine, dated in the 1st century BC, found in Troy