A 58-year-old woman from rural India presents with progressive fatigue, cold intolerance, and weight gain over 6 months. On examination, she has the clinical findings marked **A** in the diagram: puffy facies, periorbital edema, loss of lateral eyebrows, and macroglossia. Her serum TSH is 45 mIU/L and free T4 is 0.8 ng/dL. Which of the following best explains the pathophysiology of the cutaneous and tissue manifestations marked **A**?