Clinical profiles of thyroid dermopathy: a dermato-endocrinology minireview

Abstract

Background: Thyroid disorders sometimes have extra-thyroidal manifestations. Hyperthyroidism is a clinical syndrome resulting from excessive secretion of thyroid hormones. The commonest cause is Graves’ disease. About 0.5 – 4.3% of patients with Graves’ disease have an infiltrative dermopathy called thyroid dermopathy. It is due to excessive deposition of glycosaminoglycans from activated fibroblasts. Skin fibroblasts are activated by thyroid stimulating hormone receptor antibodies and the whole process is initiated by T lymphocytes. Thyroid dermopathy is rarely also found in other thyroid disorders such as Hashimoto thyroiditis. The diffuse non-pitting oedema variant is the commonest clinical presentation. Other variants include the nodular, plaque, mixed and elephantiasis types. The main concerns of the patients usually are cosmetic, discomfort and difficulty in wearing shoes. Thyroid dermopathy usually presents after the diagnosis of Graves diseases but it may present together or sometime after. Rarely, thyroid dermopathy presents before the diagnosis of Graves’ disease is made. Apart from the shin and feet, other sites that can be affected include arms, forearms, back, thighs, pinna and nose. Conclusion: The management is multidisciplinary, involving Dermatologists and Endocrinologists. Usually, controlling the thyroid dysfunction does not translate into regression of the skin lesion. However, many patients have their thyroid dermopathy regressing spontaneously while others usually require local therapy. Other therapeutic options include systemic therapy such as pentoxifylline, compressive physiotherapy and surgery.