Periorbital Edema: Is Hypothyroidism in the Differential?

In his "What's Your Diagnosis?" column, Dr Henry Schneiderman discussed thecase of a young man with periorbital swelling caused by nephrotic syndrome(CONSULTANT, June 2001, page 1017) (Figure 1). Does myxedema produce asimilar appearance?
-- Paul Snow, MD
   Cumberland, MdGenerally, the puffiness seen in myxedema involves the whole facerather than selectively the periorbital area. Although I wouldnever advise against checking a patient's thyroid-stimulating hormonelevel, my sense is that a person whose facial appearanceresembles that of the young man pictured here will prove euthyroid--or if dysthyroid, only incidentally so. Interpretation of the eyes and thyroidis complicated by the fact that a substantial number of African Americans whoare euthyroid appear to have relatively prominent globes mimicking exophthalmos,which is a sign of the opposite thyroid disorder--Graves disease withophthalmopathy (Figure 2).¹-- Henry Schneiderman, MD
   Vice-President, Medical Services
   Physician-in-Chief
   Hebrew Health Care
   West Hartford, Conn
   Professor of Medicine (Geriatrics)
   Associate Professor of Pathology
   University of Connecticut Health Center
   Farmington