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[Clinical Picture] Hypothyroidism to Graves' disease and late appearance of pretibial myxoedema

12 Oct 2019

A 57-year-old man attended our clinic complaining of orbital pain, anxiety, and a tremor. On examination, he had oedema and retraction of his eyelids and an obvious tremor. 6 months earlier, he had been diagnosed with autoimmune hypothyroidism after he began to gain weight and complained of feeling tired: his thyroid-stimulating hormone (TSH) concentration was raised at 83 mIU/L (normal range 0·3–4·6), free thyroxine (T4) concentration was 5·9 pmol/L (normal range 10–23), and the antithyroid peroxidase antibody concentration was markedly elevated at 1488 IU/mL (normal level <101).

Click here to view the full article which appeared in The Lancet