Examination
On general exam, patient noted to have a thyroid nodule and hirsutism. She was well oriented with intact cranial nerves and normal upper limb function. She however had features of thoracic myelopathy with increased lower limb reflexes, clonus, hypertonia, Babinski sign and paraparesis (worse on right side). There was a T4 sensory level and diminished anal sphincter tone and peri-anal sensation. No obvious tenderness or steps on her back and nor features of sepsis or inflammation.