Thyroid Acropachy, Circumscribed Myxœdema and Exophthalmos

Abstract

Histology.-(i) Of a fresh lesion: showed a dense inflammatory inflltrate of polymorphs, plasma cells and monocytes in the dermis, with numerous eosinophils. (ii) Of an older lesion : showed that the stratum corneum was covered by fibrin and debris which tended to be heaped up. Clefts had appeared between the prickle cells and the basal layer of the epidermis, forming a vesicle, containing numerous inflammatory cells-polymorphs, lymphocytes and plasma cells, while the displaced basal laj'er and dermal papillae also contained eosinophils, in addition to the inflammatory exudate.Treatmeni and progress.-On more than one occasion she was in extremis and blood transfusions were required on four occasions and mild cardiac failure due to steroid therapy responded to digoxin. The turning point in her illness seems to have been associated with the regular administration of pooled gammaglobulin 400 mg. twice weekly. Prednisone also seemed to influence the disorder in two ways, by inhibiting the evolution of fresh lesions and by accelerating healing. DisctrssiON.Dr. P. D. SAMMAN : Two or three years ago I saw a very similar case and, thinking that it was a severe herpes simplex primary infection, recommended treatment with gammaglobuhn. I did not see the patient again but was informed that complete recovery took place quite quickly. Attempts were made to demonstrate a virus but were not successful.

LATS activity, exophthalmos and digital clubbing associated with myxoedema

“…The occurrence of exophthalmos, pretibial myxoedema and clubbing in association with thyrotoxicosis are well known and thyroid acropachy following thyroidectomy for hyperthyroidism has been described (Sharvill, 1965). However, the presence of exophthalmos in primary myxoedema is said to be extremely infrequent (McKenzie, 1965).…”