Clinical Images  |   November 2016
Periorbital Myxedema
Author Notes
  • 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:
Article Information
Endocrinology / Imaging / Clinical Images
Clinical Images   |   November 2016
Periorbital Myxedema
The Journal of the American Osteopathic Association, November 2016, Vol. 116, 753. doi:
The Journal of the American Osteopathic Association, November 2016, Vol. 116, 753. doi:

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) 
Parving HH, Hansen JM, Nielsen SL, Rossing N, Munck O, Lassen NA. Mechanisms of edema formation in myxedema–increased protein extravasation and relatively slow lymphatic drainage. N Engl J Med. 1979;301(9):460-465. [CrossRef] [PubMed]
Means JH. The Thyroid and Its Diseases. 2nd ed. Philadelphia, PA: J.B. Lippincott; 1948:232-234.
Freedberg IM, Vogel LN. The skin in hypothyroidism. In: Braverman LE, Utiger RD, eds. Werner and Ingbar’s The Thyroid. 6th ed. Philadelphia, PA: J.B. Lippincott; 1991:985-987.