(BMJ)—An older woman presented w/ bilateral periorbital swelling, thickened skin, and coarsened facial features. Review of sx: cold intolerance, hoarse voice. Labs confirmed dx. What is it?
Nephrotic syndrome
Primary hypothyroidism
Whitaker syndrome
Scleroderma
Systemic lupus erythematosus
You are correct. The pt’s thyroid stimulating hormone levels were high and her T4 was markedly low, confirming primary hypothyroidism. Such marked edema is unusual but resolves w/ levothyroxine tx. Other possible causes of periorbital swelling include infection, allergy, skin disorders, heart failure, and renal failure.

BMJ 2019;364:l279