A previous report showed a 10% complete remission rate after an average follow-up of 3.5 years in 150 patients with pretibial myxedema. 2 According to another study of long-term outcome of pretibial myxedema in 178 patients with pretibial myxedema, a 50% complete remission rate was achieved after 17 years in patients who had gone untreated for cutaneous lesions. 3 In contrast, our patient developed a marked deterioration over a period of 14 years. Mild cases may show spontaneous regression, while severe cases such as elephantiasic pretibial myxedema are refractory to therapies. Fibroblast stimulation is suggested to play an important role in the increased production of glycosaminoglycan in myxedema; however, the differences between progressive and smoldering types are unknown. A recent report suggested a possible novel treatment with complete decongestive physiotherapy for elephantiasic enlargement of the lower legs. 4 Because our patient had stopped visiting the hospital, untreated thyroid disease, diabetes, hyperlipidemia, hypertension, and abnormality in echocardiogram were newly discovered when she revisited us after the interval. Due to the metabolic syndrome, surgical treatment for her nodular and elephantiasic myxedema of the lower legs could not be performed. In conclusion, even though the symptoms were mild at the initial presentation, long-term follow-up of pretibial myxedema is necessary to confirm the disease progression.
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