Selfie-driven thyroid disease leads: A study on a unique sign and its utility in clinical practice.

Introduction: Taking a photograph of self alone or with a group called selfie, has become modern-day rage with spurt in smartphone technology. It has catapulted from a hobby into psychiatric ailment, especially among teens and young adults. Although it is considered a psychiatric ailment keeping them aloof from social interactions, we observed an inadvertent advantage in this process. In this context, we present some intriguing findings in this study. Materials and
Methods: This retrospective study was based on compilation of 14 cases from endocrine surgery outpatient cum inpatient database collected over 2 years' period. The inclusion criteria are the chief complaint (CC) was noted only after watching the selfie picture and not otherwise; the CC leads them to consult physician; the picture was captured by oneself or other person who was also part of that image; and the CC leads to definitive diagnosis of thyroid disease requiring treatment. All other clinical, investigative, and treatment (medical and surgical) were studied.
Results: In all, we had 14/5820 (0.0024%) cases meeting the above criteria. CC and later confirmed in pictures were four cases of Grave's disease associated ophthalmopathic exophthalmos, eight cases of goiter, and two cases of facial puffiness (myxedema related). All these CC helped in investigating for the diagnosis of Graves' disease (4), nodular goiter (8), and hypothyroidism (2) confirmed by appropriate investigations. Ten cases underwent thyroidectomy (two of the nodular goiter cases were papillary thyroid cancer) and four cases took conservative medical treatment. Conclusions: Although selfie is considered a modern-day lifestyle-induced psychiatric illness, it can inadvertently help in picking up thyroid diseases in earlier stages.

INTRODUCTION

Human lives in the present modern era have become dependent on mobile and internet technologies. There are approximately 2.5 billion smartphone users worldwide and 650 million users in India.[1] The Oxford English Dictionary defines a “selfie” as a photograph that one has taken of oneself, generally with a smartphone or a web camera, that is often uploaded to a social media platform.[2] According to a study by Lee and Sung, smartphone users take approximately 93 million selfies each day.[3]

It has catapulted from a hobby in to psychiatric ailment, especially among teens and young adults. Although it is considered as a psychiatric ailment keeping them aloof from social interactions, we observed an inadvertent advantage in this process. In this context, we present some intriguing findings of its inadvertent utility in this study.

MATERIALS AND METHODS

This retrospective study was based on compilation of 14 cases from endocrine surgery outpatient cum inpatient database collected over 2 years’ period from December 2017 to November 2019. The inclusion criteria are – the chief complaint (CC) was noted only after watching the selfie picture and not otherwise; the CC leads them to consult physician; the picture was captured by oneself or other person who was also part of that image; and the CC leads to definitive diagnosis of thyroid disease requiring treatment. We termed this phenomenon as selfie driven thyroid disease leads (SET). All other clinical, investigative, and treatment (medical and surgical) were studied. Social media is defined as websites and applications, such as Facebook, WhatsApp, Twitter, and Instagram, which enable users to create and share photos and images on social networking.

All these patients were called upon and evaluated with Selfitis Behavior Scale, which is a validated tool for the assessment of selfie-related behavior. It has six components: environmental enhancement, social competition, attention seeking, mood modification, self-confidence, and social conformity.[4] These interviews were used to collect information on sociodemographic variables, smartphone use, and variables related to selfies. The study complied with the international ethical norms of the Helsinki Declaration – Ethical Principles for Medical Research Involving Human Subjects, 2004.[5] Written informed consent was obtained from all the patients for using their data, without revealing identity for a research publication. Details were entered in excel sheet and SPSS 20.0 (IBM, USA) was used for statistical analysis.

RESULTS

In all, we had 14 out of 5820 (0.0024%) cases treated in our department that met the SET criteria. CC and later confirmed in pictures were four cases of Grave's disease associated ophthalmopathic exophthalmos, eight cases of goiter, and two cases of facial puffiness (myxedema related). All these CC helped in investigating for the diagnosis of Graves’ disease (4), nodular goiter (8), and hypothyroidism (2) confirmed by appropriate investigations. The clinicopathological details of subjects are detailed in Table 1. Treatment and follow-up details are also highlighted in Table 1. All the cases underwent biochemical evaluation with thyroid profile, anti-thyroid peroxidase antibody assay for autoimmunity assessment. Ultrasonography of neck and cross-sectional imaging for large goiters was performed as part of treatment planning. Fine-needle aspiration cytology was done for goiters for disease pathology. Most of goiters were Grade 3 in size. Overall, ten cases underwent surgical thyroidectomy. Histopathological evaluation of all surgical specimens was performed.

Table 1

Clinicopathological parameters of the selfie-driven thyroid disease leads subjects

n	Age (years)	Sexa	Category of diseaseb	Histopathologyc	Treatmentd	Follow-up (months)
1	15	F	GD	HG	HT	15
2	5	F	Ht	NA	TR	30
3	22	F	NG	AG	TT	24
4	34	F	NG	PTC	TT	12
5	17	M	NG	AG	HT	18
6	21	F	GD	NA	RAI	15
7	25	F	NG	AG	TT	24
8	26	M	GD	HG	TT	12
9	29	F	Ht	NA	TR	08
10	22	F	NG	PTC	TT	15
11	19	F	GD	NA	RAI	22
12	26	F	NG	AG	TT	18
13	23	F	NG	AG	HT	24
14	20	F	NG	AG	TT	10

aF=Female, M=Male; bGD=Graves’ disease, NG=Nodular goiter, Ht=Hypothyroidism, cAG=Adenomatous goiter, HG=Hyperplastic goiter, PTC=Papillary thyroid cancer, NA=Not applicable, dTT=Total thyroidectomy, HT=Hemithyroidectomy, TR=Thyroxine replacement, RAI=Radioiodine therapy

Two of eight nodular goiter cases were papillary thyroid cancer and rest were benign [Figure 1]. 2/4 cases of Graves’ disease underwent total thyroidectomy and other two cases (Grade 1) received radio-iodine treatment [Figure 2]. None of the thyroidectomized patients had postoperative hypocalcemia or recurrent laryngeal nerve paralysis. Graves’ ophthalmopathy was treated with eye protective measures, low-dose steroids [Figure 2]. None of them needed orbital decompression or radiotherapy and resolved significantly with normalization of thyroid status. The two cases of hypothyroidism were nongoitrous and receive thyroxine replacement therapy for normalization of serum thyroid stimulating hormone. One of the cases of hypothyroidism was diagnosed after parents approached us, with one of their twin daughters showing poor scholastic performance with a dull, sallow complexioned, receding scalp hairline, hair loss, and puffy face [Figure 3]. All signs of hypothyroidism were normalized after attaining euthyroid status.

Figure 1

(a) Case of Graves’ disease showing a diffuse goiter in the neck. (b) Bilateral proptosis of Graves’ ophthalmopathy (arrow)

Figure 2

(a) Case of large nodular goiter. (b) Ex vivo specimen of total thyroidectomy and neck dissection in a case of papillary thyroid cancer

Figure 3

(a) Twin girls with the right side sister (arrow) showing puffy, dull, sallow complexion face of hypothyroidism. (b) Normally looking twins after the affected sister are rendered euthyroid with treatment

DISCUSSION

Probably, the first known selfie was taken in 1839.[6] However, in recent years, taking personal or group selfies have become very popular among young adults.[7] According to the “Mobile Technology and Home Broadband 2019” survey performed by the Pew Research Center, 96% of those aged between 18 and 29 years in the U. S. owned a smartphone;[8] another study estimated that 98% of the participants (aged 18–24) took selfies, and 69% tended to share selfies 3–20 times daily.[9] Similarly, the age group of our patients ranged from 5 to 32 years. Although the frequent age range of thyroid disease is 30–50 years, patients obtained through SET belonged into younger age group.

With the increase in the need to make selfies exciting and to gain attention on social media, dangerous selfies are becoming increasingly common.[710] Selfie-related deaths (selficide) are becoming an universal phenomenon due to risky selfie taking such as middle of traffic, at extreme heights, and crime scene.[101112] Options of photo sharing, likes, emoticons, etc., on various social media platforms such as Facebook, Instagram, WhatsApp, and Twitter also encourage selfie taking.

Any scientific innovation has got both benefits and perils, depending on how people use it. Selfie phenomenon based on smartphone technology is no exception to this scenario. Selfie taking has obvious advantages of advanced photo taking, sharing, and editing experience.[13] However, gradually, the disadvantages are outweighing the benefits.[13] The disadvantages are primarily due to behavioral patterns of users leading to psychosocial issues, security problems, health ailments, and accident risks.[1011121314] New disorders related to selfie such as selfitis and selficide are emerging. Selfitis is as a disorder of the obsessive taking of selfies. Nearly, one-fifth of the participants in our study had selfitis. This selfitis may lead to health hazards such as low back pain, cervical spondylitis, awkward posture, frozen shoulder, and tennis elbow.[15]

In spite of its apparent benefits and many disadvantages (misuse related), there have been useful nonroutine applications of this selfie taking.[13] It was successfully used in plastic/cosmetic surgery for preoperative, postoperative, and follow-up evaluation of facial changes and morphology.[16] Selfie technology combined with advanced photo editing options has been used in dermatology for assessing health of skin, skin tan and moles, etc.[17] It helped in creating easy portraits and artistry.[18] This technology was also used in counseling, evaluation of eating behaviors in adolescents and in the field of psychology/psychiatry.[19] It was also used for smoking deaddiction.[20] None of the aforementioned advantages have been used in pure clinical scenario in treatment/management of a specific disease. We highlighted a new advantage of selfie in a pure clinical setting of endocrine practice. Our article is one such paper where this unique inadvertent utility is highlighted. All the patients who were diagnosed through SET were diagnosed and cured with appropriate treatment. This according to us is an obvious benefit of selfie taking as the subject can observe changes/abnormalities in face or neck, which may be signs of an existing disease. As shown in our data, only 0.024% of cases belonged to selfie identified group. We opine that selfie takers must be appraised of noting any abnormal signs visible in their pictures and consult clinicians for early management/counseling of underlying diseases.

CONCLUSIONS

Although frequent selfie taking is considered a modern-day lifestyle-related psychosocial illness, it can inadvertently help in early pickup and optimal management of thyroid diseases, which may otherwise be overlooked for a long time.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.