LATS activity, exophthalmos and digital clubbing associated with myxoedema

Beighton, Peter

doi:10.1136/pgmj.44.511.426

Cited by 8 publications

(2 citation statements)

References 13 publications

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“…In several studies (Kriss, Pleshakor and Chein, 1964;Shasky and Nelson, 1966;Beighton, 1968), the level of long acting thyroid stimulator (LATS) was found to be high in patients with pretibial myxoedema. LATS is known to be abnormal immunoglobulin in the IgG fraction (Kriss et al, 1964;Shasky and Nelson, 1966) and is thought to be an antibody with humoral properties (Shasky and Nelson, 1966).…”

Section: Discussionmentioning

confidence: 99%

Thyrotoxic pretibial myxoedema in Asian patients in Singapore

Kee¹,

Cheah²

1975

Postgraduate Medical Journal

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SummaryOver a 5-year period, three cases of thyrotoxic pretibial myxoedema were encountered. The incidence of pretibial myxoedema in Chinese thyrotoxic patients in Singapore was 0-7yo (03y. in females and 1F6% in males). One of the three patients also had thyroid acropachy. The incidence of thyrotoxic pretibial myxoedema in Singapore is compared with that in the literature and the aetiology briefly reviewed.PRETIBIAL myxoedema is an unusual complication of thyrotoxicosis and there is scanty knowledge of its incidence. Gimlette (1960) reported an incidence of 4*3 % while Shasky and Nelson (1966) found an incidence of 1 %. There has been no previous report of the incidence of thyrotoxic pretibial myxoedema in Asians or in the tropics. This paper describes the incidence of pretibial myxoedema in Singapore over a 5-year period and the clinical features observed. Materials and methodsThere were 479 cases of thyrotoxicosis seen in the Department of Medicine (Unit I), University of Singapore, over a 5-year period, 1968Singapore, over a 5-year period, -1972. Ofthese, 322 were female and 157 were male. There were 435 Chinese, thirty-one Malays, six Indians and seven of other ethnic groups. Pretibial myxoedema was carefully looked for in all cases and it was found in three Chinese (diagnosis confirmed by skin biopsy). Two of these were male, giving an incidence of 1 6% of 129 Chinese thyrotoxic males, and one was female, giving an incidence of 0-3y. of Chinese thyrotoxic females. The overall incidence of pretibial myxoedema in Chinese thyrotoxic patients, male and female, was 0'7%/O. In addition, two of the patients had diffuse thickening of the skin and subcutaneous tissues but skin biopsies were not diagnostic; these two cases are excluded from the study. The three cases are reported in detail below. Case reports Case IA 47-year-old Chinese male storekeeper was seen Fifteen months later, he relapsed. The thyroid uptake of 131I at 4 hr was 43%O and at 24 hr, 49%. At this stage, he was noted to have bilateral circumscribed swellings over both shins. Skin biopsy of one of the swellings over the shin confirmed the diagnosis of pretibial myxoedema; there was separation of the collagen fibres probably due to interstitial oedema and mucinous degeneration of some fibres. Thyroid antibodies (tanned red cell agglutination) were positive 1: 25, and antimicrosomal antibodies were positive. The serum immunoglobulins were IgG 1520 mg/100 ml (normal 598-1086 mg/100 ml; Chew, Yu and Wee, 1969); IgA 130 mg/100 ml (normal 91-399 mg/100 ml) and IgM 26 mg/100 ml (normal 44-100 mg/100 ml). He was then treated with carbimazole for another 4 months; his pretibial myxoedema remained unchanged. A 55-year-old Chinese man presented with congestive cardiac failure. He was found to be thyrotoxic. His thyroid gland was twice normal size and was firm and nodular and he had Grade 1 bilateral exophthalmos. There was no clubbing of the fingers or toes. The resin uptake of triiodothyronine was 195% (normal 75-115°/) and his total serum thyroxine was 12-...

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Section: Discussionmentioning

confidence: 99%

Thyrotoxic pretibial myxoedema in Asian patients in Singapore

Kee¹,

Cheah²

1975

Postgraduate Medical Journal

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“…The etiology is obscure, Thomas (1933) suggesting that the change from high to low peripheral blood flow with the onset of hypothyroidism might be the provocative factor. More recently the discovery of LATS and the demonstration of a high level of activity in a number of these cases of acropachy (Beighton 1968, Kinsella & Back 1968) raises the possibility that LATS may be a contributory factor in some as yet undetermined manner.…”

Section: Discussionmentioning

confidence: 99%