Myxedema

This 56-year-old man presented with a swollen face and puffy eyelids. He recently had an ear, nose, and throat evaluation for persistent hoarseness, and the findings were normal. The patient complained that he has had difficulty in lifting his head for about 4 years and was treated by a chiropractor but obtained no relief.

Physical examination revealed yellow skin associated with carotenemia (A). Tendon reflexes demonstrated slowed relaxation of the knee and ankle jerks. The patient's heart rate was less than 60 beats per minute, and the thyroid-stimulating hormone level was above 50 µU/mL. Dr Dee Wee Lim of Moreno Valley, Calif, made the diagnosis of myxedema.

Dr Lim prescribed a 6-week course of levothyroxine in the following regimen: 0.025 mg/d for the first 2 weeks; 0.05 mg/d during the third and fourth weeks; and 0.075 mg/d thereafter. After drug therapy, the patient's symptoms-swelling, hoarseness, and difficulty in lifting his head-resolved (B). The patient, a construction worker, is doing well and has returned to work.