16 June 2015

"Banjo Goiter" -- NOT

This gentleman's affliction is all over the internet; the photos typically are watermarked "rotten.com," though I can't ascertain whether they originated there.

The images pop up in blogs and websites with commentary which typically takes one of two pathways: 1) simple amazement at the deformations the human body is capable of attaining, sometimes with a degree of pity or admiration for what the man endured, or 2) juvenile and mindless ridicule of the man as a defective specimen of humanity. At ebaumsworld the thread is peppered with "makes me want to throw up," "he should stay indoors," and the other cruelties that the anonymity of the web seems to exacerbate.

The association with the banjo is obviously fortuitous; the gentleman simply chose to pose for the photographer holding his favorite instrument.

In all cases, the assertion - stated or implied - is that this man has a goiter (enlarged thyroid). Apparently I'm going to be the first to suggest that this man does NOT have a goiter.

A goiter can cause immense enlargement of the neck, but his is not focal - it's circumferential to an extent that if caused by a thyroid would result in near-asphyxiation from compression of the trachea. And note that this man's pathology is not confined to the neck - it extends forward to lumps on his anterior chest and posteriorly to his upper back and upper arms. The overall appearance suggests fatty tissue, in a man who is certainly obese but not grotesquely so.

I've sent these photos to an academic pathologist, who emailed me back with the suggestion that this man probably has multiple symmetric lipomatosis (eponym: Madelung's disease):
diffuse lipomatous masses deposited symmetrically around the neck, back, shoulders and upper trunk.. Suprascapular and supraclavicular involvement is common and occasionally it may involve the parotid and post auricular region. The face and distal extremities are usually spared...
There is a schematic depiction here, and a sketch of diffuse lipomatosis of the neck at this link, and others retrievable with a quick Google.

Blogged not for any cosmically significant reason; correcting a misdiagnosis perpetuated in cyberspace on a man from an earlier generation is not of particular importance. But after having read some of the trash said about him, it seemed necessary to give him a moment of dignity. He had the courage to display his affliction to the world. I don't think he was embarassed by it; I think he must have come to embrace it as part of what defined him in other people's eyes. And when he sat down with his banjo for the photographer, I thought this was the kind of guy I would be pleased to have over to my house for a party.

(Reblogged from 2008 for a newer generation of readers)


  1. the girl who likes the sky but not explosionsJanuary 5, 2009 at 2:38 AM

    thanks a lot for the information about those pictures..i was sure that this problem, the man seems to have, had nothing to do with bronchocele or goiter, so called.you gave him back his lost dignity, that's for sure!

  2. Thanks for this. Well said.

  3. Goiters are caused by too little in the diet, that's why our table salt is "iodized". It's kind of an outdated condition because vitamins an minerals are so easily obtained nowadays.

  4. I just wanted to say thank you for this sober post. It's truly heartbreaking how cruel we can be to each other.. Ostracizing others because they're not particularly "pleasing" to our eye is something I see play out daily, on a large and small scale. I know I'm capable of it as well, even as I hate it.
    I know we can choose to make changes by addressing harsh thoughts/feelings when they arise in our minds, but again it's a choice.
    We're capable of horrible things. God help us to love each other.

    1. Yes. I have learned to not read comments on some websites.

  5. Well said, very interesting info, and way to stick up for this guy, sad how we all treat each other when we're not face to face

  6. Just wanted to add another "well said" to the comment list. Way to make the internet a better place!

  7. This got my attention because I have a goiter, and I can certify that it is definitely not the same thing! I don't have to be as brave as this gentleman; you likely would not notice anything strange about my neck unless you were examining me either as a medical professional or a vampire. (It's a rather tame goiter.)

    I also wanted to add that goiters are not caused only by an iodine deficiency and they are unfortunately not an outdated condition. I have an autoimmune thyroid disease, meaning my immune system has gone haywire and is attacking my thyroid. It's not at all rare.

  8. Thanks for researching that: When I first saw the photo, I thought "That doesn't really look like a goiter", so after searching for more info on the photo, I found this page and the correct information. Poor man.

  9. Thanks a lot for this helpful information =D

    Be blessed & Shalom

  10. Very interesting and informative

  11. Anytime someone adds to the dignity of another person, especially here in the interwebs, I stand and applaude...consider a round of applause to have been duly delivered for this article.

    I too was immediately impressed by this gentlemans acceptance and bravery in the face of what would have been cruel circumstances. Thanks for posting this.

  12. Thank you. I wish the rest of the internet was more like TYWKIWDBI sometimes.

  13. Adding my thanks for taking the time.

    I saw this photo on the 'net several years ago, so I guess it's just hit some sot of critical mass.

    best wishes
    another phil

  14. So strange, I saw a Madelung's Deformity this past week, and this was the other condition Dr. Madelung described.

    I'd rather have that kind of physical deformity, than to be the twisted sort who would be cruel to him.

  15. This man is a relative of mine. I'm not sure how these pics made it to the internet,as no relative posted them as we can tell. His name is George and he Lived and died in eastern Pa. We did not know what this disease was and of course many stories were told.

  16. Thank you so much for this info. Finally a diagnosis. And thank you for being kind to him.

  17. i like the military photo <3


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