An unusual cause of pancytopaenia.

A 76-year-old man was admitted to the acute medical take with a long history of tiredness. He described slowed thinking, constipation, aching thighs, dry skin, a hoarse voice, hair loss and 10 kilograms of unintentional weight loss. He had lived in Spain for 7 years and his daughter had persuaded him to return to the UK for a medical check-up.