A 40-year-old African-American man was referred to our dermatology clinic for management of his long-standing thyroid dermopathy. The patient was diagnosed with hyperthyroidism at the age of 20, and was treated with radioactive iodine I-131 but subsequently lost to follow-up. He had not consulted physicians again until the age of 30. Then he presented with severe thyroid eye disease, significant weight gain, hypothy-roidism, and painful leg swelling. Levothyroxine was initiated, which stabilized his thyroid levels but had no effect on his exophthalmos and leg swelling.

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