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Affiliation(s)
- M M Patil
- Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India
| | - S Kamalanathan
- Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India
| | - J Sahoo
- Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India
| | - N G Rajesh
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605 006, India.
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Lan C, Li C, Chen W, Mei X, Zhao J, Hu J. A Randomized Controlled Trial of Intralesional Glucocorticoid for Treating Pretibial Myxedema. J Clin Med Res 2015; 7:862-72. [PMID: 26491499 PMCID: PMC4596268 DOI: 10.14740/jocmr2303w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pretibial myxedema (PTM) is an uncommon dermopathy associated with autoimmune thyroid diseases. Now it is thought to be autoimmune and its treatment with glucocorticoid is helpful. However, it has not been evaluated. METHODS A prospective randomized controlled trial was performed in 110 patients with PTM to evaluate the efficacy and safety of triamcinolone acetonide with intralesional injection once every 3 days and once every 7 days. Randomization was performed with drawing lots and it was also stratified according to variants of PTM lesions. In the follow-up, recurrent rates were observed. The SPSS Statistics 17.0 Software was used in the statistical analysis. RESULTS The complete response rates were 78.2%, 83.6%, and 87.3% in regimen 1 and 50.9%, 89.1%, and 90.9% in regimen 2 at 3 weeks, 7 weeks and the end of therapy, respectively. Regimen 1 had an earlier efficacy than regimen 2, but at 7 weeks and end of therapy, there were no differences between two regimens. The majority of non-severe variants got complete response but severe variants did not. The adverse reaction rates in regimen 1 were higher and earlier than those in regimen 2. Adverse reaction occurring time in regimen 1 was shorter than that in regimen 2. Recurrent rates were 31.25% and 32% in regimens 1 and 2 at 3.5-year follow-up. CONCLUSIONS For its autoimmune, hyperplasia and disabled features, early treatment of PTM with glucocorticoid is necessary to get complete response. Dosage and frequency of intralesional steroid injection and lesional variants influence the efficacy of PTM. Once every 7 days is a better regimen.
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Affiliation(s)
- Changgui Lan
- Department of Dermatology, China National Nuclear Corporation 416 Hospital, No.4, Er Huan Lu Bei Si Duan, Chengdu City, Sichuan Province, China
| | - Can Li
- Department of Dermatology, China National Nuclear Corporation 416 Hospital, No.4, Er Huan Lu Bei Si Duan, Chengdu City, Sichuan Province, China
| | - Wei Chen
- Department of Dermatology, China National Nuclear Corporation 416 Hospital, No.4, Er Huan Lu Bei Si Duan, Chengdu City, Sichuan Province, China
| | - Xiaofeng Mei
- Department of Dermatology, China National Nuclear Corporation 416 Hospital, No.4, Er Huan Lu Bei Si Duan, Chengdu City, Sichuan Province, China
| | - Jing Zhao
- Department of Dermatology, China National Nuclear Corporation 416 Hospital, No.4, Er Huan Lu Bei Si Duan, Chengdu City, Sichuan Province, China
| | - Jie Hu
- Department of Dermatology, China National Nuclear Corporation 416 Hospital, No.4, Er Huan Lu Bei Si Duan, Chengdu City, Sichuan Province, China
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Nodular Foot Myxedema Masquerading as Lymphedema. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e457. [PMID: 26301146 PMCID: PMC4527631 DOI: 10.1097/gox.0000000000000427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/28/2015] [Indexed: 01/21/2023]
Abstract
Lymphedema results from abnormal development or injury to the lymphatic system. One-fourth of patients with lower extremity enlargement are erroneously labeled with “lymphedema.” We describe a patient with hypothyroidism who developed soft-tissue overgrowth of her foot. She was referred to our Lymphedema Program for management of “lymphedema” and overgrown toes. The patient’s lymphoscintigram showed normal lymphatic function in her extremities, and she was diagnosed with myxedema by histopathology. Nodular localized myxedema should be included in the differential diagnosis of lymphedema.
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Elsayad K, Kriz J, Bauch J, Scobioala S, Haverkamp U, Sunderkötter C, Eich HT. Radiation therapy as part of the therapeutic regimen for extensive multilocular myxedema in a patient with exophthalmos, myxedema and osteoarthropathy syndrome: A case report. Oncol Lett 2015; 9:2404-2408. [PMID: 26137080 DOI: 10.3892/ol.2015.2990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 02/13/2015] [Indexed: 01/04/2023] Open
Abstract
Exophthalmos, myxedema and osteoarthropathy (EMO) comprise the triad known as EMO syndrome, which is rarely observed in patients with autoimmune thyroid disease. The present study reports the case of a patient with EMO, including the response of this rare combination to radiotherapy. A 48-year-old patient with EMO syndrome presented to the Department of Radiation Oncology, University Hospital of Muenster, eight years prior to writing with therapy-resistant pretibial myxedema and hypertrophic osteoarthropathy of the metacarpal bones. The patient had been diagnosed with Graves' disease (GD) 26 years prior to presentation, which was treated by thyroidectomy and radioiodine therapy. Four years subsequent to the diagnosis of GD, the patient developed exophthalmos, which was treated using radiotherapy. An evident pretibial, foot and hand myxedema developed within the 10 years following the onset of orbitopathy. The skin lesions were treated using radiation therapy subsequent to the failure of multiple surgical procedures and medical treatments. Almost eight years subsequent to the administration of irradiation, no recurrence was observed on the lower right leg, nor was any recurrence on the lower left leg observed approximately four years subsequent to the completion of radiotherapy. However, an additional lesion on the left hand demonstrated slow progression following treatment with radiation therapy. The present study indicates that radiation therapy can be considered as adjuvant therapy for patients with refractory myxedema, to prevent or delay the recurrence of myxedema subsequent to surgical excision.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany
| | - Jan Kriz
- Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany
| | - Julia Bauch
- Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany
| | - Sergiu Scobioala
- Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany
| | - Cord Sunderkötter
- Department of Dermatology, University Hospital of Muenster, Muenster D-48149, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany
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Sendhil Kumaran M, Dutta P, Sakia U, Dogra S. Long-term follow-up and epidemiological trends in patients with pretibial myxedema: an 11-year study from a tertiary care center in northern India. Int J Dermatol 2015; 54:e280-6. [PMID: 26019115 DOI: 10.1111/ijd.12658] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 11/14/2013] [Accepted: 01/20/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pretibial myxedema (PTM) is a rare manifestation of Graves' disease. There is paucity of data regarding long-term follow-up and response to treatment in PTM. MATERIALS AND METHODS Retrospective study wherein 30 patients of PTM presenting during 2001-2011 attending dermatology and endocrinology outpatient departments were analyzed. RESULTS Among 30 patients with PTM, 12 were males and 18 females with a ratio of 1 : 1.5 males/females. Four morphological forms were identified: plaques (18 patients), diffuse non-pitting edema of both lower legs (five), nodules (five), and elephantiasis lesions (two). Eighty percent were diagnosed with hyperthyroidism before the development of dermopathy. Twenty-six patients presented with ophthalmopathy. Fourteen patients with plaque had an excellent response to topical clobetasol propionate ointment and attained complete resolution by 3.6 years. Out of 16 patients treated with combination therapy, which included nine treated with topical corticosteroids/intralesional triamcinolone and seven treated with oral, intralesional, and topical corticosteroids, nine attained complete resolution in the lesions by 3.4 years, and none relapsed anytime during four years of post-treatment follow-up. However, the remaining patients (elephantiasis and diffuse forms) failed to achieve complete resolution. CONCLUSIONS Plaques and nodules are common variants with a favorable clinical response to topical and intralesional corticosteroid; elephantine and diffuse forms responded poorly to therapy. Studies analyzing larger cohorts of patients with PTM and their long-term follow-up are limited, hence more such studies are required.
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Affiliation(s)
- Muthu Sendhil Kumaran
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Sakia
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Helfgott SM. Rheumatoid manifestations of endocrine and lipid disease. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Shirai K, Ito T, Mitsuhashi Y, Tsuboi R. Dramatic effect of low-dose oral steroid on elephantiasic pretibial myxedema. J Dermatol 2014; 41:941-2. [PMID: 25200964 DOI: 10.1111/1346-8138.12608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kohei Shirai
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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Bartalena L, Fatourechi V. Extrathyroidal manifestations of Graves' disease: a 2014 update. J Endocrinol Invest 2014; 37:691-700. [PMID: 24913238 DOI: 10.1007/s40618-014-0097-2] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 05/20/2014] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Graves' orbitopathy (GO), thyroid dermopathy (also called pretibial myxedema) and acropachy are the extrathyroidal manifestations of Graves' disease. They occur in 25, 1.5, and 0.3 % of Graves' patients, respectively. Thus, GO is the main and most common extrathyroidal manifestation. Dermopathy is usually present if the patient is also affected with GO. The very rare acropachy occurs only in patients who also have dermopathy. GO and dermopathy have an autoimmune origin and are probably triggered by autoimmunity to the TSH receptor and, likely, the IGF-1 receptor. Both GO and dermopathy may be mild to severe. MANAGEMENT Mild GO usually does not require any treatment except for local measures and preventive actions (especially refraining from smoking). Currently, moderate-to-severe and active GO is best treated by systemic glucocorticoids, but response to treatment is not optimal in many instances, and retreatments and use of other modalities (glucocorticoids, orbital radiotherapy, cyclosporine) and, in the end, rehabilitative surgery are often needed. Dermopathy is usually managed by local glucocorticoid treatment. No specific treatment is available for acropachy. PERSPECTIVES Novel treatments are presently being investigated for GO, and particular attention is paid to the use of rituximab. It is unknown whether novel treatments for GO might be useful for the other extrathyroidal manifestations. Future novel therapies shown to be beneficial for GO in randomized studies may be empirically used for dermopathy and acropachy.
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Affiliation(s)
- Luigi Bartalena
- Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy.
| | - Vahab Fatourechi
- Department of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA.
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Nair PA, Mishra A, Chaudhary A. Pretibial Myxedema Associated with Euthyroid Hashimoto's Thyroiditis: A Case Report. J Clin Diagn Res 2014; 8:YD01-2. [PMID: 25121051 DOI: 10.7860/jcdr/2014/6581.4415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 03/05/2014] [Indexed: 11/24/2022]
Abstract
Pretibial myxedema (PM) is an infiltrative dermopathy which is seen in grave's disease. It is also associated with hypothyroidism, but is infrequently seen in Hashimoto's thyroiditis. Lesions are seen commonly over pretibial region as non-pitting oedema or with a plaque morphology. Heat shock protein (HSP) has been reported to be expressed by fibroblasts present at affected site, which cause lesions of PM. Histopathology differentiates it from other dermatoses. Lesions usually resolve spontaneously, but therapies like potent topical steroids, intralesional steroids, gamma globulin, pentoxifylline, surgery and radiotherapy are indicated. Here, a case of PM with euthyroid Hashimoto's thyroiditis has been reported, which was proven by histopathology.
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Affiliation(s)
- Pragya A Nair
- Professor, Department of Dermatology and Venereology, Pramukhswami Medical College , Karamsad, Anand, Gujarat, India
| | - Ajay Mishra
- Associate Professor, Department of Medicine, Pramukhswami Medical College , Karamsad, Anand, Gujarat, India
| | - Arvind Chaudhary
- Resident, Department of Dermatology and Venereology, Pramukhswami Medical College , Karamsad, Anand, Gujarat, India
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Kim WB, Mistry N, Alavi A, Sibbald C, Sibbald RG. Pretibial Myxedema: Case Presentation and Review of Treatment Options. INT J LOW EXTR WOUND 2014; 13:152-154. [PMID: 24807996 DOI: 10.1177/1534734614531485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pretibial myxedema (PM) is a rare autoimmune manifestation of Graves' disease, which commonly presents as diffuse, nonpitting edema of shins and less often as plaques, nodules, or elephantiasis lesions mimicking lymphedema. We present a 57-year-old woman with 12-month history of PM, which occurred a year after treatment of Graves' disease and improved with topical corticosteroids, support stockings, and intralesional steroid injections until recurrence with local erythema and woody edema. A literature review was undertaken of the evidence-based treatment modalities for symptomatic PM: although commonly asymptomatic and self-limited, severe cases of PM may be treated with topical corticosteroid, compressive therapy, and intralesional corticosteroid injections.
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Affiliation(s)
- Whan B Kim
- McMaster University, Hamilton, Ontario, Canada
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García-Arnés JA, García-Casares N, Soler J, Garín JM, Garriga MJ, León M. Ureteric myxoedema. A new location in Graves' disease. Clin Endocrinol (Oxf) 2014; 80:613-4. [PMID: 23692561 DOI: 10.1111/cen.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Juan A García-Arnés
- Department of Endocrinology, Carlos Haya Regional University Hospital, Malaga, Spain.
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Abstract
The name of a condition in dermatology, gives a clue regarding the clinical feature, etiology, or histopathology of the disease. A disease might have been termed wrongly due to its resemblance to another known condition. Misnomers often mislead a physician regarding the etiology or histopathology of the condition. Here is a list of misnomers, with explanation, and the appropriate name in parentheses.
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Affiliation(s)
- Somaiah A Savitha
- From the Department of Dermatology, STD, Leprosy, Bangalore Medical College and Research Institute, Bangalore, India
| | - Sarvajnamurthy A Sacchidanand
- From the Department of Dermatology, STD, Leprosy, Bangalore Medical College and Research Institute, Bangalore, India
| | - Shilpa K Gowda
- From the Department of Dermatology, STD, Leprosy, Bangalore Medical College and Research Institute, Bangalore, India
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Brinster NK, Garrett AB, Kostopoulos TC. Localized myxedema of thyroid disease. J Am Acad Dermatol 2013; 68:e189-90. [PMID: 23680216 DOI: 10.1016/j.jaad.2012.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/16/2012] [Accepted: 11/20/2012] [Indexed: 11/28/2022]
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Couderc E, Cante V, Renaud O, Guillet G. [Graves' dermopathy on the big toe]. Ann Dermatol Venereol 2013; 140:382-5. [PMID: 23663712 DOI: 10.1016/j.annder.2013.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/29/2013] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Localized myxoedema is a rare dermopathy in patients with Graves' disease. The pretibial area is the most commonly affected region but herein we present a case of myxoedema of the big toe. PATIENTS AND METHODS A 44-year-old male with Graves' disease ongoing for seven years presented bilateral ophthalmopathy and myxoedema of the big toes. The myxoedema was treated successfully with intralesional steroids. DISCUSSION The physiopathology of myxoedema involves fibroblast activation and glycosaminoglycan production. This activation could result from stimulation of TSH receptors at their surface by TSH receptor antibodies (TRAK) or from an inflammatory process. The pretibial topography may be related to the high frequency in this area of microtrauma, with modulation of the cytokine microenvironment. CONCLUSION The atypical localization seems to correlate with a Koebner phenomenon. Treatment of Graves' disease is generally insufficient to resolve the cutaneous problems. Topical corticosteroid therapy generally results in rapid improvement of recent lesions.
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Affiliation(s)
- E Couderc
- Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
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Vannucchi G, Campi I, Covelli D, Forzenigo L, Beck-Peccoz P, Salvi M. Treatment of pretibial myxedema with dexamethazone injected subcutaneously by mesotherapy needles. Thyroid 2013; 23:626-32. [PMID: 23397966 DOI: 10.1089/thy.2012.0429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pretibial myxedema (PTM) is a rare extrathyroidal manifestation of Graves' disease that requires treatment when the clinical picture is markedly evident. In addition to topical treatment with steroid ointments, there have been previous reports of subcutaneous injections of steroids. This procedure may cause nodular degeneration of the skin due to fat atrophy when standard needles are used. In the present study, we have tried a novel modality of treatment of PTM by injecting a solution of dexamethasone in the subcutaneous tissue using needles employed for mesotherapy. These needles are ≤4 mm long and deliver the medication within the dermis or the first layer of the subcutaneous fat. We have treated five patients, four with diffuse and one with elephanthiasic PTM. We utilized multiple injections of a solution of dexamethasone, lidocaine, and saline in the PTM plaque and in the pretibial area, both in the PTM plaque and in the area surrounding the lesions, once a week for three consecutive weeks. Two patients with a more severe form of PTM underwent another two cycles four to six weeks after initial treatment. Patients were studied before and after treatment by clinical assessment and ultrasound of the pretibial skin. The treatment was well-tolerated, with only moderate pain upon injection of the solution. One month after treatment, all patients showed improvement of PTM at clinical assessment and a reduction of the thickness of the lesions at ultrasound of ∼15%, involving mostly the dermis. Moreover, all patients reported amelioration of the leg appearance. The present study, although preliminary, shows that intralesion steroid injection with mesotherapy needles in PTM is effective and well tolerated, and does not cause undesired long-term modifications of the skin. More studies are warranted to standardize such treatment in larger groups of patients.
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Affiliation(s)
- Guia Vannucchi
- Endocrine Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione Cà Granda IRCCS, Milan, Italy.
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A Triad of Exophtalmos, Pretibial Myxedema and Acropachy in a Patient With Graves’ Disease / Egzoftalmus, pretibijalni miksedem i akropatija − trijada prisutna kod obolelog od Grejsove bolesti. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2012. [DOI: 10.2478/v10249-012-0008-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
A classical triad of extrathyroidal manifestations of Graves’ disease known as EMO syndrome (exophthalmos, pretibial myxedema and osteoarthropathy) is a rare condition. This paper presents a 39-year old male patient who underwent chemo- and radiation therapy of the supradiaphragmatic area due to Hodgkin’s disease at the age of 35 and 36 leading to remission. Two years later, the patient developed general symptoms of Graves’ disease and ophthalmopathy, with high thyroid stimulating hormone levels. Four months later, the patient presented with pretibial myxedema. Thirteen months after the onset of the disease, higher levels of thyroxine and decreased levels of thyroid stimulating hormone were registered. The diagnosis of EMO syndrome was confirmed by radiologic and histopathological analyses. Thiamazole and intralesional corticosteroid therapy were administered, resulting in euthyreosis and decrease of pretibial myxedema. The question is whether the autoimmune thyroid disease was triggered by the previous disease, or by chemo- and radiation therapy..
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Abstract
Dermopathy of Graves' disease is a classical, but uncommon extrathyroidal manifestation of Graves' disease. The images of a typical case of dermopathy of Graves' disease are presented along with clinico-pathological correlation.
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Affiliation(s)
- Sagili Vijaya Bhaskar Reddy
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sushil Kumar Gupta
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract
Optimum care of the patient with Graves ophthalmopathy (GO) is achieved through teamwork between the endocrinologist and ophthalmologist, with input from ancillary specialists as needed. Clinical evaluation should include determination of both the severity and the activity of the disease. It is important to assess early in the evaluation the impact of the disease on the patient's quality of life and their priorities and expectations regarding management. Once this information has been gathered, careful discussion between patient and physicians can define the management plan. This article reviews the pathophysiology, epidemiology, evaluation, and management of GO.
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Affiliation(s)
- Marius N. Stan
- Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic School of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - James A. Garrity
- Department of Ophthalmology, Mayo Clinic School of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Rebecca S. Bahn
- Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic School of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
- Corresponding author.
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Abstract
Obesity is a serious global health problem, perhaps the biggest public health issue of our times. Excess body weight may be a factor in carcinogenesis in general, as well as contributing to the pathogenesis of metabolic, cardiovascular and musculoskeletal disorders. Obesity also has many cutaneous features, which form the basis for this review article. Many of these clinical entities are common to the majority of obese patients, e.g. striae distensae, plantar hyperkeratosis and an increased risk of skin infections. However, it may also be associated with poor wound healing, malignant melanoma and an increased risk of inflammatory dermatoses, such as psoriasis, as well as some rarer disorders. Therapeutic interventions for obesity, whether over-the-counter, prescription medicines or surgical interventions, are increasingly commonplace. All of these treatment modalities potentially have dermatological side-effects too.
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Affiliation(s)
- A R Shipman
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
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Gómez-Bernal S, Ruiz-González I, Delgado-Vicente S, Alonso-Alonso T, Rodríguez-Prieto MÁ. Plaque-like cutaneous mucinosis after joint replacement. J Cutan Pathol 2011; 39:562-4. [DOI: 10.1111/j.1600-0560.2011.01838.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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James Evans R, Scilley C. Massive Localized Lymphedema: A Case Series and Literature Review. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011. [DOI: 10.1177/229255031101900309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A large, deep, soft tissue mass is often malignant in nature; however, a recent study described a large soft tissue mass present in morbidly obese patients that was found to be benign. Massive localized lymphedema (MLL) is a large pedunculated lymphadematous mass found in the lower extremity of morbidly obese patients. MLL often enlarges over many years and may interfere with mobility. Although histologically similar to well-differentiated liposarcoma, MLL has recently emerged as a separate, benign clinical entity. The pathophysiology of MLL is yet to be understood. A literature review, and the authors’ experiences are discussed to assist in clinical decision making.
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Affiliation(s)
- Robin James Evans
- Division of Plastic Surgery, Department of Surgery, University of Western Ontario, London, Ontario
| | - Chris Scilley
- Division of Plastic Surgery, Department of Surgery, University of Western Ontario, London, Ontario
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Elephantiasic thyroid dermopathy. Am J Med 2011; 124:e1-2. [PMID: 21497784 DOI: 10.1016/j.amjmed.2011.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/21/2011] [Accepted: 02/23/2011] [Indexed: 11/24/2022]
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75
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Supraclavicular swelling in hypothyroidism. Curr Opin Pediatr 2011; 23:482-5. [PMID: 21602679 DOI: 10.1097/mop.0b013e3283481ad4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hypothyroidism can have a variety of presentations. We report here a case of acquired hypothyroidism in a pediatric patient who first presented with bilateral supraclavicular swelling. Hypothyroidism and its presenting signs and symptoms are discussed with a focus on the less common findings that can be associated with hypothyroidism in children.
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76
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Abstract
BACKGROUND Pretibial myxedema (PM) is an uncommon and characteristic manifestation of Graves' disease (GD), with local autoimmune reaction in cutaneous tissue. The treatment of PM is a clinical challenge. We herein report a patient with PM who achieved complete remission by multipoint subcutaneous injection of long-acting glucocorticid. SUMMARY A 38-year-old man presented with an 18-month history of GD and a 1-year history of PM. Physical examination revealed mildly prominent eyes, diffuse enlargement of the thyroid gland, and PM of both lower extremities. The patient was treated with triamcinolone acetonide by multipoint subcutaneous injections in a combined dose of 20 mg in each lower extremity administered every 25-28 days. The injection was started from the borderline of the lesions and normal skin by selecting 4 to 5 points per leg for each course and then moving to other parts in subsequent courses of treatment. The depth of needle insertion was 0.5-1.0 cm. The patient's PM achieved complete remission in both lower extremities after an approximately 6-month period that included seven courses of treatment with a total dosage of 280 mg triamcinolone acetonide. CONCLUSIONS Our experience with this patient suggests that multipoint subcutaneous injection of long-acting glucocorticid is a safe, effective, and convenient treatment of PM in patients with GD.
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Affiliation(s)
- Aimin Deng
- Endocrinology Department, Guangzhou General Hospital of Guangzhou Military Command Region, Guangzhou, China.
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77
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Helfgott SM. Rheumatoid manifestations of endocrine and lipid disease. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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78
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Chiu HH, Chen GS, Wu CS, Wu CC, Lan CCE. Clinical and pathological appearance of localized lower leg mucinosis. J Dermatol 2010; 37:929-33. [PMID: 20860750 DOI: 10.1111/j.1346-8138.2010.00911.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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79
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Ibrahim T, Jammal M, Tselikas L, Tiev K, Tolédano C, Josselin L, Gain M, Cabane J, Kettaneh A. Rétention urinaire et œdème. Rev Med Interne 2010; 31:502-3. [DOI: 10.1016/j.revmed.2009.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 06/30/2009] [Indexed: 11/29/2022]
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80
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Mishriki YY. Puzzles in Practice. Postgrad Med 2010; 122:162-4. [DOI: 10.3810/pgm.2010.03.2134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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81
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Affiliation(s)
- A Klepfish
- Blood Bank and Hematology Department, E. Wolfson Medical Centre, Holon and Sackler Faculty of Medicine, Tel Aviv University
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82
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Abstract
Graves’ ophthalmopathy, also called Graves’ orbitopathy, is a potentially sight-threatening ocular disease that has puzzled physicians and scientists for nearly two centuries.1 –3 Generally occurring in patients with hyperthyroidism or a history of hyperthyroidism due to Graves’ disease, Graves’ ophthalmopathy is also known as thyroid-associated ophthalmopathy or thyroid eye disease, because it sometimes occurs in patients with euthyroid or hypothyroid chronic autoimmune thyroiditis. The condition has an annual adjusted incidence rate of 16 women and 3 men per 100,000 population.4 This review explores the perplexing relationship between Graves’ ophthalmopathy, hyperthyroidism, and thyroid dermopathy, the associated skin condition. I examine clinical features, histologic findings, and laboratory studies, with an emphasis on mechanisms that could be targeted in the development of new treatments for this debilitating disease.
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Affiliation(s)
- Rebecca S Bahn
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA.
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83
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Takasu N, Higa H, Kinjou Y. Treatment of pretibial myxedema (PTM) with topical steroid ointment application with sealing cover (steroid occlusive dressing technique: steroid ODT) in Graves' patients. Intern Med 2010; 49:665-9. [PMID: 20371956 DOI: 10.2169/internalmedicine.49.2617] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Localized pretibial myxedema (PTM) is a sign of Graves' disease. A 53-year-old man with Graves' disease was admitted with the development of PTM following radioisotope (131)I treatment for Graves' hyperthyroidism. TSH receptor antibody (TRAb) titer was also increased after (131)I treatment. TRAb was measured as thyroid stimulating antibody (TSAb) or TSH-binding inhibitory immunoglobulin (TBII). PTM was noted several months after (131)I treatment. The PTM-development seems to be associated with the increased TRAb-activities. The localized pretibial myxedema was effectively treated with topical steroid (triamcinolone acetonide) ointment application with sealing cover (steroid occlusive dressing technique: steroid ODT). We also report our experience of PTM-treatment with steroid ODT in 5 other PTM patients with positive TRAb. PTM was successfully treated with steroid ODT in two patients. In these two patients, the treatment was started within several months of the appearance of PTM. In the other 4 patients, the treatment was started 5-10 years after the appearance of PTM without any beneficial effects. Early detection and early treatment are necessary for the remission of PTM.
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Affiliation(s)
- Nobuyuki Takasu
- Center of Endocrinology and Metabolism, Medical Plaza Daido, Naha.
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84
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Takahashi Y, Nakagawa Y, Fujishima F, Mori K. A swollen index finger as a presentation of thyroid dermopathy. Intern Med 2010; 49:1831. [PMID: 20720369 DOI: 10.2169/internalmedicine.49.3971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yurie Takahashi
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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85
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Ali O, McCann C. A 16-year-old male with lower extremity dermopathy. J Pediatr Endocrinol Metab 2009; 22:481-2. [PMID: 19694193 DOI: 10.1515/jpem.2009.22.6.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Omar Ali
- Medical College of Wisconsin, Milwaukee, WI, USA.
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86
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Bergersen TK, Mørk C. [A 62-year-old woman with non-pitting leg oedema]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:750-2. [PMID: 19373301 DOI: 10.4045/tidsskr.09.34625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
A patient presented with non-pitting lymphoedema of the legs and finger clubbing. A skin biopsy showed epidermal hyperkeratosis and abundant mucinous material (Alcian blue positive) in reticular dermis. Treatment (radioactive iodine) for Grave's disease (with exophthalmus) 20 years ago, raised suspicion of thyroid dermopathy. Together, these three extrathyroidal manifestations of Graves' disease are typical of the EMO syndrome. In addition, the patient had elevated serum concentrations of thyroid-stimulating hormone receptor autoantibodies. Autoimmune mechanisms are involved in the stimulation of fibroblasts and the production of large amounts of mucin. Pretibial myxoedema relates to scars, mechanical factors, and dependent position. Lack of steroid treatment during radioactive iodine therapy and smoking, may have exacerbated the thyroid dermopathy in this case. Awareness of pretibial myxoedema as a late autoimmune manifestation of Graves' disease, may contribute to earlier diagnosis and correct treatment.
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87
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Rongioletti F, Donati P, Amantea A, Ferrara G, Montinari M, Santoro F, Parodi A. Obesity-associated lymphoedematous mucinosis. J Cutan Pathol 2009; 36:1089-94. [PMID: 19222694 DOI: 10.1111/j.1600-0560.2008.01239.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mucin deposition on the shins is considered as an indicator of pretibial myxoedema, which is typically seen in patients with Graves' disease. OBJECTIVE The purpose of this study was to report the clinical and histopathological features of a group of patients with pretibial mucinosis in the absence of thyroid disease. METHODS Five patients are included in this series and studied both clinically and histologically and compared with similar cases in the literature. RESULTS All patients were middle aged or elderly. Four patients were women. They were characterized clinically by morbid obesity and bilateral lower extremity pitting oedema sparing the feet. Semitranslucent papules and/or nodules and sometimes vesicles were found on the shins. Characteristic histological features include (i) hyperorthokeratosis with epidermal atrophy and effacement of the rete ridge pattern, (ii) oedema in the papillary and upper part of the reticular dermis with mucin deposition stained positively with alcian blue and colloidal iron, (iii) angioplasia in the upper part of dermis with upward-running, increased and thickened capillary vessels and (iv) variable fibrosis in the reticular dermis with separation of collagen bundles and increased stellate or linear fibroblasts. A hypocaloric diet was given in two cases, and an important weight loss was observed, which was accompanied by a marked improvement of the pretibial mucinosis. CONCLUSIONS Pretibial mucinosis is a histological feature associated with morbid obesity and lymphoedematous features of the legs that should be distinguished from true pretibial myxoedema. The term of 'obesity-associated lymphoedematous mucinosis' seems to be appropriate for this condition.
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88
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Khalilzadeh O, Mojazi Amiri H, Tahvildari M, Anvari M, Esteghamati A, Mobarra Z, Tehranchinia Z, Rashidi A, Amirzargar A. Pretibial myxedema is associated with polymorphism in exon 1 of CTLA-4 gene in patients with Graves’ ophthalmopathy. Arch Dermatol Res 2008; 301:719-23. [DOI: 10.1007/s00403-008-0919-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 11/11/2008] [Indexed: 01/27/2023]
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89
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Affiliation(s)
- Firas Al Niaimi
- Department of Dermatology, Cumberland Infirmary, Carlisle CA2 7HY
| | - Neil H Cox
- Department of Dermatology, Cumberland Infirmary, Carlisle CA2 7HY
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90
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Vos XG, Smit N, Endert E, Tijssen JGP, Wiersinga WM. Frequency and characteristics of TBII-seronegative patients in a population with untreated Graves' hyperthyroidism: a prospective study. Clin Endocrinol (Oxf) 2008; 69:311-7. [PMID: 18208575 DOI: 10.1111/j.1365-2265.2008.03192.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE It is claimed that second generation thyrotropin-binding inhibitory immunoglobulin (TBII) assays have a very high sensitivity for the diagnosis of Graves' hyperthyroidism (GH). However, studies evaluating the accuracy of TBII have been retrospective in nature and/or GH had not been diagnosed independently of TBII. The aim of the present study, therefore, was to prospectively evaluate the frequency and characteristics of TBII-seronegative patients in a population of untreated GH diagnosed independent of serum TBII. DESIGN Prospective multicentre observational study. PATIENTS A total of 259 consecutive untreated patients with a first episode of GH, diagnosed independent of serum TBII. TBII levels were measured by second generation assay and correlated to thyroid function, clinical characteristics and exposure to environmental factors. RESULTS Serum TBII was positive in 245 (94.6%) patients and negative (< 2 IU/l) in 14 (5.4%) patients. TBII-seronegative patients had lower fT4 (median 42.5 vs. 53.9 pmol/l, P = 0.02), T3 (median 3.55 vs. 4.90 nmol/l, P < 0.01) and fT3-index (median 4.30 vs. 6.27, P < 0.01) compared to TBII-seropositive patients. None of the TBII-seronegative patients had TSH-receptor activating mutations, Graves' orbitopathy or pretibial myxedema. Serum TBII was positively correlated to free T3 (fT3)-index and free T4 (fT4)-index (P < 0.01), goitre size (P < 0.01) and the prevalence of Graves' orbitopathy (P < 0.01). There were no significant differences between TBII-seropositive and TBII-seronegative patients in environmental factors. CONCLUSION The prevalence of TBII-seronegativity in untreated patients with GH is 5.4% using a second generation assay. TBII-seronegative patients have biochemically less severe thyrotoxicosis and no Graves' orbitopathy. TBII-seronegative and TBII-seropositive patients apparently belong to the same population of GH, albeit the severity of the autoimmune attack is less in TBII-seronegative patients.
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Affiliation(s)
- Xander G Vos
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdamn, Amsterdam, The Netherlands.
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91
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Marconi B, Brandozzi G, Galeazzi A, Campanati A, Simonetti O, Santinelli A, Pisa E, Offidani A. A case of pretibial myxoedema associated to ectopic secreting thyroid nodule on thyroglossal duct residue. J Eur Acad Dermatol Venereol 2008; 22:620-1. [DOI: 10.1111/j.1468-3083.2007.02419.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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92
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Wiersinga WM, Bleumink M, Saeed P, Baldeschi L, Prummel MF. Is sleeping position related to asymmetry in bilateral Graves' ophthalmopathy? Thyroid 2008; 18:541-4. [PMID: 18407753 DOI: 10.1089/thy.2007.0302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In agreement with the systemic nature of Graves' disease, Graves' ophthalmopathy (GO) presents as a symmetric bilateral eye disease in the vast majority of patients. However, asymmetric involvement of both eyes is frequently observed. We hypothesized that sleeping position might be involved in asymmetric GO; when, for example, the preferred sleeping position is on the right side, retrobulbar pressure might be somewhat higher in the right than in the left orbit, resulting in more severe eye changes in the right eye. METHODS A prospective study in 75 consecutive untreated patients with GO, in whom eye changes and sleeping position were assessed independent of each other. Criteria for asymmetric eye changes were differences between both eyes in the presence of retrobulbar pain or of > or =1 grade in soft tissue involvement, and/or of > or =2 mm in exophthalmos, and/or > or =8 degrees in elevation. Preferred sleeping position was determined by questionnaire. RESULTS All patients had bilateral GO. Eye changes were symmetrical in 50 patients, and asymmetrical in 25 patients based on differences in proptosis and elevation. Sleeping position did not differ between symmetric and asymmetric GO. Preferred sleeping position was on the left side in 23%; on the right side in 31%; and on the back, on the belly, or unknown in 46%. In patients with asymmetric GO, the most affected ("worst") eye was not related to preferred sleeping position on the right or left side. CONCLUSION Slight asymmetry of eye changes between both eyes in patients with bilateral GO is not related to preferred sleeping position on either the right or left side.
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Affiliation(s)
- Wilmar M Wiersinga
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, The Netherlands.
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93
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Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Tørring O. TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study. Eur J Endocrinol 2008; 158:69-75. [PMID: 18166819 DOI: 10.1530/eje-07-0450] [Citation(s) in RCA: 241] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Autoimmunity against the TSH receptor is a key pathogenic element in Graves' disease. The autoimmune aberration may be modified by therapy of the hyperthyroidism. OBJECTIVE To compare the effects of the common types of therapy for Graves' hyperthyroidism on TSH-receptor autoimmunity. METHODS Patients with newly diagnosed Graves' hyperthyroidism aged 20-55 years were randomized to medical therapy, thyroid surgery, or radioiodine therapy (radioiodine was only given to patients > or = 35 years of age). L-thyroxine (L-T4) was added to therapy as appropriate to keep patients euthyroid. Anti-thyroid drugs were withdrawn after 18 months of therapy. TSH-receptor antibodies (TRAb) in serum were measured before and for 5 years after the initiation of therapy. RESULTS Medical therapy (n=48) and surgery (n=47) were followed by a gradual decrease in TRAb in serum, with the disappearance of TRAb in 70-80% of the patients after 18 months. Radioiodine therapy (n=36) led to a 1-year long worsening of autoimmunity against the TSH receptor, and the number of patients entering remission of TSH-receptor autoimmunity with the disappearance of TRAb from serum during the following years was considerably lower than with the other types of therapy. CONCLUSION The majority of patients with Graves' disease gradually enter remission of TSH-receptor autoimmunity during medical or after surgical therapy, with no difference between the types of therapy. Remission of TSH-receptor autoimmunity after radioiodine therapy is less common.
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Affiliation(s)
- Peter Laurberg
- Department of Endocrinology and Internal Medicine, Aalborg Hospital, Aarhus University Hospital, DK-9000 Aalborg, Denmark.
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94
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Abstract
Thyrotoxicosis is a condition resulting from elevated levels of thyroid hormone. In this article, the authors review the presentation, diagnosis, and management of various causes of thyrotoxicosis.
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Affiliation(s)
- Bindu Nayak
- Division of Endocrinology and Metabolism, Georgetown University Hospital, 4000 Reservoir Road, Building D, Suite 232, Washington, DC 20007, USA.
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95
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Abstract
Thyroid disorders commonly have dermatologic manifestations. The purpose of the present chapter is to review and emphasize potential clinical dermatologic findings that can occur with Graves' disease, hypothyroidism and thyroid cancer. In autoimmune diseases such as Graves' disease and Hashimoto's thyroiditis the skin manifestations may be related to either thyroid hormone levels themselves or to the associated T and/or B cell abnormalities. Thyroid cancer may be associated with various syndromes that could have significant skin manifestations.
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Affiliation(s)
- Kenneth D Burman
- Endocrine Section and Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA.
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96
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Abstract
The skin is a target organ of several hormones. Specific diseases appear in consequence of hypo- or hypersecretion of endocrine organs, particularly in the elderly patient. There, knowledge of skin alterations is important not only for dermatologists, but also for endocrinologists and other physicians, because a clinical diagnosis of the underlying disease is often possible. In this review, a number of representative skin diseases having an endocrinological basis are described. These include acanthosis nigricans, diseases due to alterations of androgen metabolism, carcinoid syndrome, diseases due to alterations of corticosteroid metabolism, diseases in association with diabetes mellitus, diseases due to alterations of estrogen metabolism, genetic syndromes including dermatological and endocrine symptoms, the glucagonoma syndrome, diseases due to dysfunctions of growth hormone secretion, diseases in association with Merkel cells of the skin, diseases due to dysfunctions of the thyroid gland, diseases to alteration of vitamin D metabolism, and vitiligo and disorders of pigmentation.
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Affiliation(s)
- Walter Krause
- Department of Dermatology, Philipps University, Marburg, Germany.
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