Localized Myxedema on the Upper Eyelids in a Patient of Hypothyroidism

A 42-year-old Japanese woman presented with upper eyelid swelling of 2 months duration (Figure 1a). She did not complain muscle weakness or myalgia. She showed no dry coarse skin, tremors of the hands, thick tongue, or loss of hair. Histopathology of the skin biopsy revealed swelling of the collagen bundles with splitted individual fibers accompanied with pale material (Figure 1b), which was stained with blue with colloidal iron (Figure 1c).Laboratory investigation revealed decreased free T4 (0.88 ng/ml(1-1.8)), decreased free T3 (1.12 pg/ml (2.73-4.5)), and increased TSH (10.34 IU/ml (0.27-4.29). Anti-thyroid, anti-microsome, antithyrogloblin and anti-thyroid peroxidase antibodies were positive.Total cholesterol (286 mg/dl) and triglyceride (342 mg/dl) were elevated.