Modified shoe for adjusting hard stuffy and smelly sole: An uncommon accompaniment of hypothyroidism.

Disorders of smell and taste are both neglected as well as underreported problems of hypothyroidism. A 35-year-old male presented with intolerance to cold, dryness of skin, and swelling of both feet and some foul smelling odor from his feet. When we examined his feet we found that instead of wearing his shoes properly he had just slipped his feet inside the shoe so that the odor from his feet is not smelled by us. Although this symptom was largely ignored by many doctors, the literature mentions that patients of hypothyroidism may perceive dysosmia (distortion of smell) and hyposmia (elevated threshold for detection of smell).

INTRODUCTION

Dysomia and hyposmia are uncommon symptoms of hypothyroidism. These symptoms are generally ignored by both the physicians and the patients. We present here one such case where the patient presented with such symptoms but was diagnosed timely and treated.

CASE REPORT

A 35-year-old male presented with intolerance to cold, dryness of skin, and swelling of both feet and some foul smelling odor from his feet. He was a non-tobacco user, non-alcoholic, and did not have any history of hypertension or diabetes. On examination his pulse was 60/minute, B.P. 114/87 mm Hg, waist 92 cm, and BMI 28.78. His systemic examination was normal.

When we examined his feet we found that instead of wearing his shoes properly he had just slipped his feet inside the shoe [Figure 1]. On further interrogation he told us that he had stopped using shoes because of swelling of his feet, but before entering in our clinic he had borrowed the shoes from his friend so that the odor from his feet is not smelled by us.

Figure 1

Shoes of patient with hypothyroidism

We made an initial diagnosis of hypothyroidism based on his clinical symptoms which was later confirmed by elevated TSH of 150.0 μIU/L. His ECG had bradycardia.

DISCUSSION

Disorders of smell and taste are both neglected as well as underreported problems of hypothyroidism. This case was diagnosed as hypothyroidism by both clinical and laboratory examination. However the abnormal smell coming from his feet was largely ignored by most of his earlier treating doctors. It has been reported in that literature that patients of hypothyroidism may perceive dysosmia (distortion of smell) and hyposmia (elevated threshold for detection of smell). In a study[1] it was found that out of 18 untreated patients of primary hypothyroidism, 3 patients had dysomia which was improved after treating hypothyroidism. It has also been shown that experimental induction of hypothyroidism in laboratory animals resulted in development of anosmia[2] as well as delayed development of orientation along the olfactory gradient[3]

CONCLUSION

This case reminds us that the patients symptoms should never be ignored (abnormal odor in this case) and he should be examined from head to toe as some finding in patients physique will give a vital clue to reach diagnosis (wearing shoes abnormally in this case).