It has been an interesting few weeks. So many doctors from all over the world have responded to Miss Webb's case.1 Numerous differential diagnoses were suggested, including Eisenmenger's syndrome, obstructive sleep apnoea, chest infection, drug overdose, heart failure, pulmonary embolism, myasthenia gravis, Guillan-Barré syndrome, atlanto-axial subluxation, Addison's disease, hypoparathyroidism, glomerulonephritis, sepsis with immune deficiency, atrial septal defect, and adult respiratory distress syndrome. Some readers questioned the diagnosis of Down's syndrome and some felt that we had deliberately withheld relevant information to make the case more interesting (definitely, not true).

Nevertheless, many respondents got the diagnosis of hypothyroidism, even from just the first part of the …