This clinical photograph shows a front-view extraoral assessment of a 38-year-old female patient exhibiting classic signs of facial myxedema and weight gain associated with uncontrolled hypothyroidism. The facial contour is noticeably rounded, presenting a 'moon face' appearance with generalized fullness and obscuration of the underlying bony jawline and malar landmarks. Key visible features include bilateral periorbital puffiness, prominent soft tissue swelling in the cheeks (buccal fat pad region), and increased subcutaneous adipose tissue in the submental and cervical areas, leading to a less defined neck-to-jaw transition. The skin appears somewhat thickened with diffuse hyperpigmentation, particularly across the malar regions. These findings are characteristic clinical manifestations of thyroid dysfunction, reflecting the systemic metabolic effects and mucopolysaccharide deposition in dermal tissues. This visual material serves as an educational reference for identifying secondary systemic symptoms during a dental or general medical examination, specifically in patients with comorbid diabetes mellitus and hypothyroidism.

A series of four clinical photographs (a–d) documenting the progression of a pediatric patient with primary congenital hypothyroidism before and after treatment. Images (a) and (b) represent the patient at admission, exhibiting classic symptoms of untreated hypothyroidism: severe abdominal distension (pseudo-obstruction secondary to constipation), an umbilical hernia, generalized myxedema, and visible irritability. Facial features in (b) show macroglossia (enlarged tongue), rarefied eyebrows, and brittle, sparse hair. Images (c) and (d) depict the same patient six months after initiating levothyroxine sodium replacement therapy. These images demonstrate significant clinical improvement, including the complete resolution of abdominal distension (c) and achievement of developmental milestones, such as sitting without support (d). The comparison illustrates the systemic effects of thyroid hormone deficiency on metabolism, gastrointestinal motility, and neurodevelopmental progress in infants, as well as the efficacy of hormonal replacement.

A clinical photograph displaying the frontal view of a 58-year-old male exhibiting classic signs of myxedematous facies associated with primary hypothyroidism. Notable features include bilateral periorbital edema, most pronounced in the right lower eyelid, which appears as a soft, fluid-filled swelling. The patient presents with generalized facial puffiness, particularly around the mid-face and jawline, contributing to a characteristic 'moon-like' facial contour. The skin demonstrates a yellowish, pale tonality (pallor) and a dry texture consistent with xeroderma. Additional visible findings include deep forehead wrinkling, significant skin laxity in the lower facial region, and sparse lateral eyebrows. This image serves as a clinical illustration of the cutaneous and soft tissue manifestations of severe thyroid hormone deficiency, illustrating the accumulation of glycosaminoglycans in the dermis.

This clinical photograph displays a three-panel series of infants illustrating classic physical manifestations of untreated congenital primary hypothyroidism at three months of age. The first two panels focus on facial features, showing coarse facial features, puffy eyelids (periorbital edema), and a characteristic 'myxedematous' facies. Notably, the infants exhibit a flat nasal bridge, macroglossia (an enlarged, protruding tongue), and thickened skin with prominent forehead wrinkling. The third panel shows an infant with a markedly distended abdomen and a prominent umbilical hernia, another hallmark sign of the condition. Additional visible indicators include sparse hair and an overall lethargic or dull appearance. These images serve as a pedagogical example of the clinical progression of hypothyroidism in infants who missed neonatal screening, highlighting the multisystemic physical signs that accompany developmental delay and metabolic insufficiency in early infancy.