However, neurological symptoms are not as prominent and patients tend to have a history of malnutrition. Hypothyroidism (A) can present very similarly to patients with anaemia. Symptoms such as fatigue, tiredness and weakness are common to both pathologies. In hypothyroidism, a macrocytic anaemia is also present, however neurological symptoms tend to differ. In hypothyroidism, pseudomyotonic reflexes tend to occur whereby a prolonged relaxation phase occurs. Liver disease (D) and alcohol abuse can cause a macrocytic anaemia presentation. However, in liver disease, there are other peripheral stigmata such as gynaecomastia, spider naevia, caput medusae, etc). In alcohol abuse, malnutrition may cause anaemia or direct toxicity to the bone marrow. There is usually a history of alcohol abuse and other features, such as Wernicke’s encephalopathy, can develop.