A 78-year-old British gentleman presents with tiredness, poor appetite and weight gain. He has noticed that his voice has become hoarse and deep. His hearing has also worsened over recent months. A photo of the patient is shown below:
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This man has several clinical features consistent with a diagnosis of hypothyroidism. He also has numerous facial features consistent with the diagnosis.
The typical clinical features of hypothyroidism include:
- Tiredness and lethargy
- Cold sensitivity
- Dry skin
- Impaired concentration and memory
- Increased weight
- Decreased appetite
- Hoarse voice
- Reduced hearing / deafness
Image sourced from Wikipedia
Courtesy of Dr. L.F. Herbert et al. CC BY-SA 2.5
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This patient has several of the typical ‘myxoedema facies’ seen in hypothyroidism, including:
- Puffiness / oedematous facial appearance
- Loss of the outer third of the eyebrows
- Apathetic facial appearance
- Facial pallor
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The commonest cause of hypothyroidism in the U.K. is autoimmune thyroiditis. When this occurs in combination with a goitre, it is referred to as Hashimoto’s thyroiditis.
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