Rosh Internal Medicine Practice Exam

In hypothyroidism, a buildup of mucopolysaccharides in the dermis leads to non-pitting edema called myxedema. This often shows up around the eyes as periorbital puffiness, a classic physical finding in untreated or long-standing hypothyroidism. The edema is due to the interstitial accumulation of glycosaminoglycans, not fluid overload from vascular leakage, and it tends to be more prominent in the face and around the eyes. Exophthalmos, by contrast, is more typical of Graves disease (hyperthyroidism) and results from inflammation and enlargement of the extraocular muscles, pushing the eyes forward. Jaundice points to liver or hemolytic processes, not a thyroid-related edema. Erythema nodosum is a panniculitis presenting as tender nodules on the shins, unrelated to thyroid function. So the periorbital swelling described here fits hypothyroidism best because of the myxedematous facial edema pattern.