Myxedema in a 47-year-old Woman

For 2 months, a 47-year-old woman experienced constipation, weakness, fatigue, and dry skin. She also complained of moderate weight gain and menorrhagia during the same period. The patient took no medications and denied any allergies.

Thinning scalp hair, coarse skin, a sallow complexion, and bilateral swelling of the legs were noted. Bradycardia and delayed relaxation of the deep tendon reflexes of the arms were found. The thyroid gland was symmetrically enlarged. Laboratory test results included elevated levels of creatinine phosphokinase and cholesterol; the thyrotropin level was 78 µIU/mL. A diagnosis of hypothyroidism secondary to Hashimoto thyroiditis was made.

Gopi Rana-Mukkavilli, MD of New York comments that myxedema of the lower extremities secondary to hypothyroidism manifests as nontender swelling caused by mucopolysaccharide infiltration of the subcutaneous tissues. Puffy swelling of the periorbital area also may occur in these patients.

Treatment consists of thyroid hormone replacement. This patient received oral levothyroxine, 100 µg/d. Several months after this regimen was started, the leg swelling diminished substantially and the other symptoms also abated.