Hypothyroid Face

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Acromegaly

The increased growth hormone of acromegaly produces enlargement of both bone and soft tissues. The head is elongated, with bony prominence of the forehead, nose, and lower jaw. Soft tissues of the nose, lips, and ears also enlarge. The facial features appear generally coarsened.

Myxedema

The patient with severe hypothyroidism (myxedema) has a dull, puffy facies. The edema, often particularly pronounced around the eyes, does not pit with pressure. The hair and eyebrows are dry, coarse, and thinned. The skin is dry.

Hypothyroid Facies
dry skin

Nephrotic Syndrome

The face is edematous and often pale. Swelling usually appears first around the eyes and in the morning. The eyes may become slitlike when edema is severe.

Periorbital Edema The Morning
Periorbital edema

Lips may be swollen

Acromegaly Eyebrow

Brow prominent

Soft tissues of nose, ears, lips enlarged

Jaw prominent

Brow prominent

Soft tissues of nose, ears, lips enlarged

Jaw prominent

Myxedema Facies

Moon face

Red cheeks

Hirsutism

Cushing's Syndrome

The increased adrenal hormone production of Cushing's syndrome produces a round or "moon" face with red cheeks. Excessive hair growth may be present in the mustache and sideburn areas and on the chin.

Moon face

Red cheeks

Hirsutism

Parotid Gland Enlargement

Chronic bilateral asymptomatic parotid gland enlargement may be associated with obesity, diabetes, cirrhosis, and other conditions. Note the swellings anterior to the ear lobes and above the angles of the jaw. Gradual unilateral enlargement suggests neoplasm. Acute enlargement is seen in mumps.

Hypothyroid Facial Expression
Local swelling obscures ear lobe

Parkinson's Disease

Decreased facial mobility blunts expression. A masklike face may result, with decreased blinking and a characteristic stare. Since the neck and upper trunk tend to flex forward, the patient seems to peer upward toward the observer. Facial skin becomes oily, and drooling may occur.

Facial Myxedema

Stare

Decreasd mobility

Stare

Decreasd mobility

TABLE 5-4 ■ Visual Field Defects

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