PMC4454036_01
A 56-year-old male patient suffered from EMA. (a), exorbitism; (b), myxedema; and (c), acropachy
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F1
Admission tests showed a pulse rate of 77/min, a hyperthyroidism face, erubescence and moistening all over the body without yellow-stained and hemorrhagic spots in the skin and mucous membranes, no perceived systemic superficial lymphadenectasis, positive three tremor syndrome, obvious bisymmetrical exophthalmos (Figure 1a), conjunctival congestion of both eyes with non-yellow-stained sclera, isometrical round pupils with a diameter of approximately 4 mm, which were sensitive to light, upper eyelid retraction, blepharodiastasis, positive Stellwag's, Von Graefe's, Joffroy's, and Mobius' signs, no distention of neck veins with a negative hepatojugular reflux sign, the trachea in the middle, and two degrees of bisymmetrically enlarged thyroids with soft texture and smooth surfaces but without pain, nodules, tremor, or vascular murmurs, which moved up and down with swallowing. He had obvious clubbed fingers of both hands (Fig. 1b). Skin hyperplasia of the lower shanks was obvious with string-of-beads changes (Fig. 1c).