Important features include:

  • Swelling which is characteristically boggy and non-pitting and is most marked in the skin of the hands, feet, eyelids and in the supraclavicular fossa (a depression just above the collar bone)
  • Carpal tunnel syndrome: One of the nerve in the arm (forearm and hand) known as median nerve is compressed at the wrist causing the hands to tingle, hurt or have abnormal sensations.
  • Enlargement of tongue causing slurred speech
  • Hearing loss (caused by swelling in the middle ear)
  • Facial pallor (paleness) due to anemia and vasoconstriction
  • Skin is pale and cold (due to constriction of blood vessels in the skin)
  • Hypercarotenemia gives the skin a yellow tint (but does not involve the eye)
  • Thinning of outer halves of the eyebrows
  • Purple lips and malar flush (redness of cheeks)
  • Effusion (collection of fluid) into the pleural (around the lung), pericardial (around the heart) and in the peritoneal (abdominal) cavity. Heart enlargement (“myxedema heart”) is often due to pericardial effusion. Heart rate is slow.