Image Challenge – Aug 11

A 72 year old gentleman comes to the office with progressive fatigue, dry skin, muscle weakness, and unexplained weight gain. On exam you see this:

From CMAJ (Psst – No peaking!)

QUESTION: What is the name of the clinical sign in this image? What is the the most likely underlying diagnosis?

Appreciate the loss of the outer 1/3 of the eyebrows on this patient. This is known as the Queen Anne sign. You can also appreciate some mild orbital edema, scaly dry skin. Given the additional history of fatigue, weakness, weight gain, putting all this together the most likely diagnosis is hypothyroidism. Indeed, the CMAJ article written by Drs Kobylianskii and Gold at TGH describes this patient case. He was found to have a TSH of 204, and undetectable T3 and T4 levels and was appropriately treated for severe hypothyroidism.

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