Pediatric endocrinologist gives iconic 'Mona Lisa' a second medical opinion

April 17, 2019

Leonardo da Vinci's world-renowned "Mona Lisa" painting of Lisa Gherardini has captivated millions since it was created in the early 1500s, including experts in the medical community. For years, scientists and physicians have studied the discoloration of Gherardini's skin, the thickness of her neck, and her enigmatic smile to hypothesize about her health during the Renaissance time period.

The most recent published theory suggests she suffered from severe hypothyroidism, or underactive thyroid. The cardiologist cites her yellow skin, the enlarged appearance of her thyroid gland, and lack of eyebrows as symptoms to support his theory. He also writes that her mysterious smile may represent a hint of resulting psychomotor retardation and muscle weakness.

Not so fast, said Michael Yafi, MD, a pediatric endocrinologist at The University of Texas Health Science Center at Houston (UTHealth).

"I felt a personal responsibility to defend the "Mona Lisa" and the fascinating lady the painting portrays," said Yafi, the director of the Division of Pediatric Endocrinology at McGovern Medical School and a specialist with UT Physicians, the clinical practice of UTHealth. "She has inspired thousands of people over the past few centuries. I couldn't have the public thinking she had hypothyroidism, when it seems to me she was euthyroid, meaning her thyroid was normal. So, I decided to give her a fresh 21st-century medical opinion."

Yafi's opinion was recently published in Hormones-International Journal of Endocrinology and Metabolism. In it, he explains that the documentation of thyroid disease is well known in art history, and this painting doesn't match the countless other depictions of goiters, or enlargements of the thyroid gland.

"Artists often depicted what they saw in society. Sculptures from the ancient Andean and Egyptian civilizations recorded endemic goiters in areas of environmental iodine deficiency, like the Tuscany region where Gherardini lived. Ancient Greek art represents this symptom as well, as do several poetic works and even Shakespearean literature. If Gherardini had a goiter from iodine deficiency, it would have been severe and more clearly demarcated in the painting like the other historical representations; a talented painter like da Vinci would have had no problem expressing it," Yafi said.

Yafi also points out that many of da Vinci's paintings depict women without eyebrows, so it's not conclusive to attribute that feature to underactive thyroid.

Additionally, he says the yellowing of the skin only develops after a long duration of the disease. Typically, having long-term hypothyroidism would have severely affected fertility, but Gherardini is known to have given birth to five children, including one only months before sitting for the painting.

"The discoloration could simply be attributed to the age of the artwork, as well as the varnish applied by the artist. Furthermore, the painting was stolen and then hidden away for almost three years, and someone also once vandalized it with acid in an act of sabotage," Yafi said.

And as for the mysterious smile and the proposal that it's caused by muscle weakness:

"Making a diagnosis of hypothyroidism on the basis of subtle and vague features in an old painting is, needless to say, risky," Yafi said. "Hypothyroid myopathy, or muscle tissue disease, manifests in muscles that are closer to the body's midline. It is usually severe, which means that it would have prevented Gherardini from posing with a straight back. Moreover, there are plenty of people who have an asymmetric smile, but this does not necessarily mean that they are hypothyroid."

Yafi, an avid art lover and active member of Houston's art community, enjoys studying the intersection between art and medicine. His second medical diagnosis of a famous piece of art, this time focused on Edward Munch's "The Scream," was just published in Hektoen International, A Journal of Medical Humanities.

"Artists and art interpreters throughout history were able to detect many diagnoses and conditions, even before doctors. However, they weren't always correct," he said. "The artwork or person in the artwork may need a second opinion, or even third or fourth, based on current medical or scientific discoveries. It's always best to keep an open mind."
-end-


University of Texas Health Science Center at Houston

Related Hypothyroidism Articles from Brightsurf:

Adults with endocrine disorders have an increased risk of heart disease
All adults with endocrine disorders should be tested for high cholesterol and triglycerides to evaluate their risk of heart attack or stroke, according to a Clinical Practice Guideline issued today by the Endocrine Society.

Reduced hormone supply in pregnant mothers linked to ADHD in their children
Low levels of key, body-regulating chemicals in mothers during the first three months of pregnancy may interfere with the baby's brain development, a large American study shows.

Study: Synthetic medication and desiccated thyroid equally effective to treat hypothyroidism
A study by researchers at Kaiser Permanente in Denver, Colorado evaluated the stability of thyroid stimulating hormone (TSH) in patients using synthetic medication versus those using desiccated thyroid products to treat hypothyroidism.

Possible genetic link found between hypothyroidism and development of canine T-zone lymphoma
A genetic mutation might be the reason dogs with hypothyroidism are less likely to develop T-zone lymphoma (TZL).

Levothyroxine doesn't improve cardiac function for heart attack patients
Tens of thousands of patients with underactive thyroid are being prescribed Levothyroxine after a heart attack - but the results a of a double-blind randomised clinical trial has shown that it offers no benefits to their heart function.

Iodine exposure in the NICU may lead to decrease in thyroid function, NIH study suggests
Exposure to iodine used for medical procedures in a neonatal intensive care unit (NICU) may increase an infant's risk for congenital hypothyroidism (loss of thyroid function), suggests a study by researchers at the National Institutes of Health and other institutions.

Thyroid dysfunction in pregnancy being overdiagnosed, overtreated
The current practice of testing most pregnant women for thyroid stimulating hormone (TSH) may be leading to overdiagnosis and overtreatment, according to new research in CMAJ (Canadian Medical Association Journal). http://www.cmaj.ca/lookup/doi/10.1503/cmaj.191664

Hypothyroidism patients cite effectiveness in choosing alternative to standard therapy
Three in four hypothyroidism patients who chose desiccated thyroid extract (DTE) over the standard therapy said this option was more effective than other thyroid hormone medications, according to an analysis of comments in online patient forums accepted for presentation at ENDO 2020, the Endocrine Society's annual meeting, and publication in a special supplemental section of the Journal of the Endocrine Society.

Underactive thyroid more common in people working long hours
Adults who work long hours are more likely to have hypothyroidism, which is an underactive thyroid, according to study results accepted for presentation at ENDO 2020, the Endocrine Society's annual meeting, and publication in a special supplemental section of the Journal of the Endocrine Society.

Thyroid hormone use may raise death risk in older adults
Thyroid hormone replacement therapy in older adults is associated with a higher risk of death compared with no treatment, a large study finds.

Read More: Hypothyroidism News and Hypothyroidism Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.