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Periorbital Myxedema

  • Jimmy Tam Huy and Christopher Thomas Doig
Published/Copyright: November 1, 2016
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 116 Issue 11

Keywords: hypothyroidism; myxedema; periorbital myxedema

Keywords: hypothyroidism, myxedema, periorbital myxedema

A 71-year-old woman with a history of hypothyroidism presented to the emergency department with dyspnea. Physical examination revealed massive lower eyelid edema bilaterally (image) and dry, flaky skin on her lower extremities. Vital signs were normal. Further investigation revealed that the patient had been noncompliant with her prescribed levothyroxine for more than a year. The results of biochemical tests revealed a thyroid-stimulating hormone level of 220 mIU/L and a free thyroxine level of 0.15 µg/dL. The patient was admitted to the hospital, where a 0.1-mg intravenous dose of levothyroxine was administered daily for 3 days.

Myxedema, a clinical condition associated with hypothyroidism, refers to thickened, nonpitting edematous changes to soft tissues due to deposition of mucopolysaccharides in the dermis.1 Periorbital myxedema is present in 70% to 85% of patients with hypothyroidism, and 90% of patients with periorbital myxedema have hypothyroidism.2,3 Untreated, hypothyroidism can lead to myxedema coma—a rare, life-threatening condition. Management of myxedema varies depending on the severity of a patient’s hypothyroidism.3 (doi:10.7556/jaoa.2016.148)

From the Department of Internal Medicine at Garden City Hospital in Michigan.

*Address correspondence to Jimmy Tam Huy Pham, DO, MHS, MA, Department of Internal Medicine, Garden City Hospital, 6245 Inkster Rd, Garden City, MI 48135-4001. E-mail:

References

1. Parving HH , HansenJM, NielsenSL, RossingN, MunckO, LassenNA. Mechanisms of edema formation in myxedema–increased protein extravasation and relatively slow lymphatic drainage. N Engl J Med. 1979;301(9):460-465.10.1056/NEJM197908303010902Search in Google Scholar PubMed

2. Means JH . The Thyroid and Its Diseases. 2nd ed. Philadelphia, PA: J.B. Lippincott; 1948:232-234.Search in Google Scholar

3. Freedberg IM , VogelLN. The skin in hypothyroidism. In: BravermanLE, UtigerRD, eds. Werner and Ingbar’s The Thyroid. 6th ed. Philadelphia, PA: J.B. Lippincott; 1991:985-987.Search in Google Scholar
Received: 2016-07-13
Accepted: 2016-07-18
Published Online: 2016-11-01
Published in Print: 2016-11-01

© 2016 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  3. EDITORIAL
  4. Moving Medical Knowledge, Discovery, and Osteopathic Health Care Forward
  5. ORIGINAL CONTRIBUTION
  6. PROMOTE Study: Safety of Osteopathic Manipulative Treatment During the Third Trimester by Labor and Delivery Outcomes
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  10. MEDICAL EDUCATION
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  14. SPECIAL COMMUNICATION
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  16. CLINICAL IMAGES
  17. Periorbital Myxedema
https://doi.org/10.7556/jaoa.2016.148
Keywords for this article
hypothyroidism; myxedema; periorbital myxedema
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Bulletproof Silk: Observations of Dr George E. Goodfellow, the Gunfighter’s Surgeon
  3. EDITORIAL
  4. Moving Medical Knowledge, Discovery, and Osteopathic Health Care Forward
  5. ORIGINAL CONTRIBUTION
  6. PROMOTE Study: Safety of Osteopathic Manipulative Treatment During the Third Trimester by Labor and Delivery Outcomes
  7. 10.7556/jaoa.2016.141
  8. BRIEF REPORT
  9. Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects: The PROMOTE Study Protocol
  10. MEDICAL EDUCATION
  11. Does Replacing Live Demonstration With Instructional Videos Improve Student Satisfaction and Osteopathic Manipulative Treatment Examination Performance?
  12. Faculty Development Directed at Curricular Reforms Designed to Improve Patient Outcomes
  13. Outcomes-Oriented Medical Training: A Critical Curricular Design Consideration in Developing 21st Century Health Care Professionals
  14. SPECIAL COMMUNICATION
  15. Programmatic Approach to Increasing Osteopathic Medical Student Participation in Research: The TCOM Experience
  16. CLINICAL IMAGES
  17. Periorbital Myxedema
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