I want to look good: a case of Calcium fluoratum

I met the patient, a 40-year-old man, in September 2011. His main complaints were his current diagnosis of “hyperthyroidism” and his high blood pressure.
He appeared clean and was well dressed, slim but athletic in appearance. His eyes showed a slight exophthalmos (1). He was meticulous about his appearance and his health, and presented his case in detail. He lives healthily, exercises regularly and regularly monitors his body fat, his weight and his blood pressure. He is very health-conscious and becomes anxious when something is wrong; therefore his hyperthyroidism causes him considerable anxiety, particularly regarding his ability to work and providing for his young family.

Hyperthyroidism
My patient did not present the typical picture of hyperthyroidism - that is, he was neither restless, nor hungry, nor hot, nor did he continually lose weight. He felt tired and did not sleep well, although this had been almost normal for him since the birth of his children. His appetite and energy level were as before. He was somewhat nervous and often had palpitations when his blood pressure was high. A thyroid specialist diagnosed Graves' disease. When he first noticed he was unwell he weighed 85 kg, and at the time of our first appointment he weighed 81.5 kg.

Loose ligaments
His other symptoms were lower back pain, worse when driving and when standing. He complained of weak, loose ligaments, so his muscles always had to compensate, which led to tension. He wears glasses, and he had been told that the ligaments around his eye sockets were loose.

Worries about his health and about providing for his family
“What if I never get better, how can I then feed my family?”
He tries to see the positive side: “But at times like this my symptoms are not getting better; I don't believe I'll get well again. Will my heart rate ever be like it was before?”
He fears that stress and anxiety will raise his blood pressure when it is measured.

It means a lot to me to look good; I want to have a nice body, to present a pleasant appearance, and it is very important to me to look good. I never wanted to gain weight, I have a body-fat scale and constantly check my weight.”

Family
Although he has a good relationship with his parents and relatives, he sometimes feels rejected by his family. He feels they do not spend enough time together since he moved to Ottawa. Previously he had felt that his father was more drawn to his religion than to his family. He himself had been shy and lacking in self-confidence, but: “Through my university studies I came out of my shell.”