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Identify both pictures
Both images are from medical study notes and show clinical photographs illustrating endocrine disorders.
Image 1 (first photo - front and side view of an adult):
This shows a case of Myxedema - the notes below the photo confirm this. The patient displays the classic features:
- Puffy, swollen face due to non-pitting edema from mucopolysaccharide accumulation in the skin
- Coarse facial features
- Dull, expressionless appearance
Myxedema is caused by hypothyroidism (thyroid hormone deficiency) in adults, leading to weight gain, slow metabolism, fatigue, cold intolerance, and slow heart rate. It is treated with thyroid hormone replacement therapy.
Image 2 (second photo - child's face):
This also shows Myxedema, but in a child/younger patient. The notes below this image again label it "Myxedema" with features including:
- Puffy face with non-pitting edema
- Dry, coarse skin
- Slow speech, fatigue, and cold intolerance
- Weight gain and bradycardia
The page above this image also mentions Acromegaly (caused by excess growth hormone after puberty, resulting in enlarged hands and coarse facial features), which is a separate condition shown elsewhere in the notes.
Summary Table:
| Feature | Myxedema |
|---|---|
| Cause | Thyroid hormone deficiency |
| Facial appearance | Puffy, non-pitting edema |
| Skin | Dry, coarse |
| Other signs | Bradycardia, weight gain, cold intolerance, fatigue |
| Treatment | Thyroid hormone replacement |
Both photos are classic textbook clinical images used to illustrate the facial appearance of myxedema (hypothyroidism).This is a classic textbook clinical photograph of Myxedema (Hypothyroidism) in an adult female patient.
Clinical Features Visible in the Image:
| Feature | What You See |
|---|---|
| Puffy, rounded face | Generalized facial puffiness due to mucopolysaccharide deposition |
| Periorbital edema | Swelling around both eyes (baggy, droopy eyelids) |
| Dull, expressionless facies | Blank, apathetic facial expression |
| Coarse facial features | Broadened nose, thickened lips |
| Double chin / thick neck | Facial and neck puffiness |
| Dry-looking skin | Characteristic of hypothyroidism |
Diagnosis: Myxedema
This is caused by severe, long-standing hypothyroidism (thyroid hormone deficiency) in adults. The puffiness is due to non-pitting edema - an accumulation of hydrophilic mucopolysaccharides (glycosaminoglycans) in the dermis, which draws in water.
Key distinguishing point: Unlike regular edema, pressing on myxedematous skin does not leave a pit.
Associated Systemic Features (not visible but expected):
- Bradycardia
- Weight gain
- Cold intolerance
- Constipation
- Slow speech and movements
- Hair loss and brittle nails
Treatment: Levothyroxine (T4) replacement therapy - lifelong.This is the same patient and same photograph as the previous image - just a clearer, better-framed version from the textbook page.
Diagnosis: Myxedema (Severe Hypothyroidism)
The clearer image now allows better appreciation of the classic features:
Facial Features Visible:
| Feature | Clinical Significance |
|---|---|
| Severe periorbital puffiness | Non-pitting edema from glycosaminoglycan deposition |
| Drooping, heavy eyelids (ptosis-like) | Periorbital myxedematous infiltration |
| Rounded, moon-like face | Generalized facial edema |
| Coarse, thickened features | Skin infiltration by mucopolysaccharides |
| Expressionless, dull facies | Reflects slowed mentation and psychomotor retardation |
| Thick neck / double chin | Subcutaneous edema + possible goiter |
| Dry-appearing skin | Reduced sweat gland activity due to low T3/T4 |
Pathophysiology of the facial appearance:
In hypothyroidism, reduced thyroid hormones lead to accumulation of hyaluronic acid and chondroitin sulfate in the dermis. These are hydrophilic molecules that attract and retain water, causing the characteristic non-pitting, doughy swelling of the face, hands, and body - clinically called myxedema.
Quick Diagnosis Recap:
- Condition: Myxedema (adult hypothyroidism)
- Cause: Thyroid hormone deficiency (most commonly autoimmune - Hashimoto's thyroiditis)
- Treatment: Levothyroxine (synthetic T4) - lifelong replacement
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