Dermopathy of Graves’ Disease (Pretibial Myxedema): Long-Term Outcome

Abstract

Little is known about the long-term outcome of patients with thyroid dermopathy, an extrathyroidal manifestation of Graves' disease. Also, it is not known to what degree treatment promotes remission of the lesions. The present report supplies information on the natural course of mild, untreated and severe, treated thyroid dermopathy. In this study, we report on the outcomes of 178 patients seen at our institution between January 1969 and November 1995 with thyroid dermopathy who were followed up for an average of 7.9 yr. Nonpitting edema was the most prevalent form of dermopathy (43.3%), and the pretibial area was the region most commonly involved (99.4%). The majority of patients with dermopathy had ophthalmopathy (97.0%). Topical corticosteroids were the most commonly used treatment (53.9%). Patients with milder forms of dermopathy (40.4%) did not receive any therapy for dermopathy. Twenty-six percent of the patients experienced complete remission, 24.2% had moderate improvement (partial remission), and 50.0% had no or minimal improvement of their dermopathy at last follow-up. Patients who did not receive therapy experienced a significantly (P = 0.03) higher rate of complete remission (34.7%) than those who received local therapy (18.7%), although the combined complete and partial remission rates were not significantly different for the treated and untreated groups (P = 0.3). However, the treated and untreated groups were not comparable because our practice is to use therapy for more extensive and severe cases. All five cases of elephantiasis were in the treatment group and were less likely to have remission because of the severity of their skin condition. Patients receiving treatment were more likely to have dermatologic consultation and histologic diagnosis (P < 0.001). The beneficial effect of topical corticosteroid therapy on long-term remission rates remains to be determined.

Hypothyroid Graves’ disease complicated with elephantiasis nostras verrucosa (ENV): a case report and review of the literature

“…It develops after periods of prolonged standing with dependent edema. In a recent study, Schwartz et al [14] reported 150 patients with TD, 43.3% with non-pitting edema, 27% with plaques, 18.5% with nodules, 2.8% with elephantiastic morphologies, and 8.4% with an unclassified form. In this report, there were five patients with elephantiastic dermopathy.…”

“…Occlusion of small lymphatics leads to the accumulation of fluid, swelling, and dermal edema of the affected region. The pretibial area is most commonly involved (99% of the patients with thyroid dermopathy) [14]. In fact, GAG deposition occurs throughout the body without any clinical manifestation [15], but lesions are most often localized in the lower extremities.…”

“…ENV is characterized by greatly thickened skin and a persistent swelling of one or both lower legs. Patients with pretibial myxedema have higher serum concentrations of TSH receptor (TSHR) antibodies than patients with fewer extrathyroidal manifestations of Graves' disease [5,14]. In particular, patients with ENV have very high titers of TSHR antibodies.…”

Multipoint Subcutaneous Injection of Long-Acting Glucocorticid as a Cure for Pretibial Myxedema

“…It occurs most commonly in the lower third of the pretibial region, although it can also involve the feet, toes, knees, upper extremities, or even the face. Ninety percent of patients with PM have hyperthyroidism, and the other 10% may either have hypothyroidism or be euthyroid (1). The pathogenesis of PM is unclear but there appear to be interactions of immunologic, cellular, and mechanical processes (2).…”

“…Most previous studies advocated the external use of glucocorticoids, with the lesion covered with a plastic film to achieve more efficacy (1,(7)(8)(9). There is a recent study reporting a 32-year-old man of PM being treated by subcutaneous injection of triamcinolone acetonide at a large dose (10 mL, 5 mg/mL) monthly (10).…”