Case Presentation: A 40-year-old man presented with a 2-year history of progressively worsening symptoms of hoarseness, easy fatigability, constipation, and cold intolerance. He denied having swelling in the anterior aspect of the neck and had no history of a neck surgical procedure or exposure to irradiation. He was initially treated symptomatically by general practitioners; this intervention yielded no improvement. Examination revealed a pulse rate of 52 beats/min, normotension, bilateral nonpitting edema of the legs, delayed relaxation of deep tendon jerks, and a dull expressionless face with puffy eyelids (Fig. 1 and 2). An old photograph (Fig. 3) is provided for comparison. There was no evidence of goiter, and the rest of the systemic examination showed normal findings. What Is the classic sign seen in the photographs?
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