Pedal edema in a female of RS3PE

摘要

A 74-year-old woman developed bilateral pedal edema [Figure 1] in her course of treatment with levothyroxine for hypothyroidism. The dose was augmented but symptoms persisted. When she came to us, her pitting edema was limited to hands and feet. Laboratory data showed no sign of cardiac, hepatic or renal failure. Thyroid hormone levels were adequate (fT3 3.6 pg/ml, fT4 1.4 ng/dl, TSH 12.5 muU/ml). The, fT4 levels were in normal range and TSH levels were a little less than 10.0 microIU/ml as targeted. Her C-reactive protein (CRP) was augmented to 10.73 mg/dl and WBC count was 8,700/mm~3. Her rheumatoid factor and anti-nuclear antibody including RNP, Sm and double-strand DNA were all negative. We thus suspected on remitting seronegative symmetrical synovitis with pitting edema (RS3PE).