Echographic diagnosis of pretibial myxedema in patients with autoimmune thyroid disease

Abstract

In the present study we have evaluated the use of pretibial ultrasound for the diagnosis of pretibial myxedema (PTM). We studied 76 patients, 58 with Graves' disease, 13 with Hashimoto's thyroiditis and five with idiopathic hypothyroidism. Thirty-two normal subjects were also studied as controls. Sixty-four patients had associated ophthalmopathy. The ultrasound scanner was equipped with 10- and 13-MHz probes. Punch biopsies were carried out in 11 patients and tissue sections examined on a light microscope. On clinical examination 21 patients (28%) had suspected PTM. By ultrasound, we measured the thickness of dermis and subcutaneous tissue (D1) and that including only deeper dermis (D2) in normal subjects to define the echographic parameters of normal pretibial skin. We then found increased skin thickness in 25 patients (33%), with mean D1 and D2 values significantly higher than those measured in controls (p < 0.00001). The echographic study was positive in 20 patients with ophthalmopathy (31%). Ultrasound showed increased skin thickness in 16 of 21 patients (76%) with clinically suspected PTM. Histopathological findings confirmed the presence of PTM in all the patients who underwent pretibial skin biopsy. We believe that the measurement of pretibial skin thickness by ultrasound may be useful for revealing the presence of PTM.

Observing pretibial myxedema in patients with Graves' disease using digital infrared thermal imaging and high-resolution ultrasonography: for better records, early detection, and further investigation

“…3). This finding was compatible with the study by Salvi et al (21) in 1994. They found increased skin thickness in 76% of patients with clinically suspected Graves' dermopathy.…”

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

“…Wortsman et al (17) found, on the basis of preradial skin biopsies, that preradial GAG deposition might occur commonly in patients with Graves' disease, although this result was not found in an- a In a multivariate logistic regression model with a stepwise selection procedure (P Ͻ 0.05), transantral orbital decompression surgery and hyperthyroidism are the only two predictors to enter the model. Salvi et al (19), using ultrasonography, found increased pretibial skin thickness in 33% of patients with autoimmune thyroid disease, suggesting that dermopathy may be much more prevalent at the subclinical level than is diagnosed. Salvi et al (19), using ultrasonography, found increased pretibial skin thickness in 33% of patients with autoimmune thyroid disease, suggesting that dermopathy may be much more prevalent at the subclinical level than is diagnosed.…”

Clinico-pathological Study of Pretibial Region Changes in Graves’ Disease

“…In our study we found that patients who had clinical evidence of pretibial myxedema also had significantly elevated level of thyrotropin. Histology has been used in some cases to confirm the diagnosis while pretibial ultrasound was used to diagnose this disorder in one other case [9]. On histopathology of the pretibial region we found epidermal changes in 16.67 % and dermal changes in 33.33% of cases of Graves' disease with or without clinical myxedema.…”