You are correct. TSH was >100 mIU/L (reference range, 0.3-5.6), and free thyroxine was <2.0 pmol/L (7.8-14.4). Patients w/ longstanding hypothyroidism can develop lymphedema. This is thought to result from reduced lymph clearance and increased albumin in the interstitial and extracellular space, owing to a lack of thyroxine metabolism. The resulting chronic lymphedema manifests in the skin as discoloration, verrucous deformity, hyperplasia, hyperkeratosis, papillomatosis, and eventually elephantiasis, which is known as elephantiasis nostras verrucosa. The image shows the extensive gross dermatological change that can be associated w/ chronic hypothyroidism.