Nodular Pretibial Myxedema with Graves’ Disease: A Case Report
Keywords:
Pretibial myxedema, Graves’ diseaseAbstract
Pretibial myxedema is one of the classic clinical triad of Graves’ disease, along with diffuse thyroid gland enlargement and exophthalmos. It is characterized by cutaneous induration due to mucin deposition and typically occurred on extensor surfaces of the legs. The pathogenesis of localized dermopathy is still not fully understood, but it is most likely due to dermal fibroblasts stimulation caused by anti-thyroid stimulating hormone (TSH) antibodies, resulting in excessive production of glycosaminoglcans and hyaluronic acid. Other trigger factors include trauma, smoking, and obesity. There are five distinct clinical variants for pretibial myxedema including the typical diffuse and non-pitting edema form, plaques form, nodular form, mixture form, and the most severe elephantiasis form. Although cutaneous lesions can persist even with effective treatment for thyroid, supportive and symptomatic treatment may be considered. In this case report, we report a case of bilateral pretibial myxedema with an uncommon nodular variant with improvement after intralesional corticosteroids was administered.
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