Dermopathy of Graves' Disease

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     A 51-year-old woman presented with weight loss (despite good appetite), palpitations, tremor, and heat intolerance. On examination, she had typical features of Graves' disease, including a diffusely enlarged thyroid, periorbital edema, and proptosis, as well as mild thickening of the skin in the pretibial area. The diagnosis was confirmed by the results of thyroid-function tests, which showed a thyroid-stimulating hormone level of less than 0.1 mU per milliliter (normal range, 0.5 to 5.15); a triiodothyronine level of 557 ng per deciliter (8.5 nmol per liter; normal range, 100 to 190 ng [1.5 to 2.9 nmol]); and a thyroxine level of 17.9 μg per deciliter (230.6 nmol per liter; normal range, 4.4 to 12.5 μg [56.6 to 160.9 nmol]). She responded to antithyroid treatment with methimazole and propranolol and then had recurrent thyrotoxicosis when the medications were discontinued. Two years later, she underwent a near-total thyroidectomy. Postoperatively, she had normal thyroid function with levothyroxine supplementation, but her pretibial skin changes worsened. The dermopathy extended bilaterally from just below the knees to the feet (Panels A and B). The skin was leathery in texture, with hyperkeratosis, fissuring, formation of verrucous nodules, and a change in pigment. A trial of therapy with topical steroids and compressive dressings was initiated without any noticeable improvement after one year.

    Shih-Ping Cheng, M.D.

    Chien-Liang Liu, M.D.

    Mackay Memorial Hospital

    Taipei 10449, Taiwan

    http://www.100md.com/html/DirDu/2007/01/01/32/76/11.htm