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On initial laboratory evaluation in our clinic, she was found to have a thyrotropin level greater than assay. With initiation of oral levothyroxine supplementation, her dyspnoea and oedema completely resolved. The case illustrates how indigenous patients in rural Guatemala experience many barriers to accessing high-quality medical care. As a result, presentations of common illnesses are often very advanced and definitive diagnoses and treatments are frequently delayed.<\/jats:p>","DOI":"10.1136\/bcr-2016-218506","type":"journal-article","created":{"date-parts":[[2017,3,9]],"date-time":"2017-03-09T10:35:10Z","timestamp":1489055710000},"page":"bcr2016218506","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Myxoedema in a patient with achondroplasia in rural area of Guatemala"],"prefix":"10.1136","volume":"2017","author":[{"given":"Michel","family":"Juarez","sequence":"first","affiliation":[{"name":"Wuqu\u2019 Kawoq, Santiago Sacatep\u00e9quez, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7274-8315","authenticated-orcid":false,"given":"Peter","family":"Rohloff","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,3,9]]},"reference":[{"key":"2025082803222082000_2017.mar09_1.bcr2016218506.1","unstructured":"UNICEF. 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