Conversely, onycholysis can present in Graves’ disease patients who are biochemically hypothyroid as described in 2018. A 46-year-old women who presented with signs and symptoms of hypothyroidism such as bradycardia and delayed reflexes found to be biochemically hypothyroid with positive TSH receptor antibodies demonstrated characteristic Plummers nails as seen in Figure 2 (22). The gene discussed is TSHR; the disease is Graves disease.