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Figuerêdo J, Krebs K, Pujol-Gualdo N, Haller T, Võsa U, Volke V, Laisk T, Mägi R. Uncovering the shared genetic components of thyroid disorders and reproductive health. Eur J Endocrinol 2024; 191:211-222. [PMID: 39067062 DOI: 10.1093/ejendo/lvae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/22/2024] [Accepted: 07/26/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE The aim of the study is to map the shared genetic component and relationships between thyroid and reproductive health traits to improve the understanding of the interplay between those domains. DESIGN A large-scale genetic analysis of thyroid traits (hyper- and hypothyroidism, and thyroid-stimulating hormone levels) was conducted in up to 743 088 individuals of European ancestry from various cohorts. METHODS We evaluated genetic associations using genome-wide association study (GWAS) meta-analysis, GWAS Catalog lookup, gene prioritization, mouse phenotype lookup, and genetic correlation analysis. RESULTS GWAS meta-analysis results for thyroid phenotypes showed that 50 lead variants out of 253 (including 5/52 of the novel hits) were linked to reproductive health in previous literature. Genetic correlation analyses revealed significant correlations between hypothyroidism and reproductive phenotypes. The results showed that 31.9% of thyroid-associated genes also had an impact on reproductive phenotypes, with the most affected functions being related to genitourinary tract issues. CONCLUSIONS The study discovers novel genetic loci linked to thyroid phenotypes and highlights the shared genetic determinants between thyroid function and reproductive health, providing evidence for the genetic pleiotropy and shared biological mechanisms between these traits in both sexes.
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Affiliation(s)
- Jéssica Figuerêdo
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Natàlia Pujol-Gualdo
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Toomas Haller
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Urmo Võsa
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Vallo Volke
- Department of Pathophysiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Triin Laisk
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
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2
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Wang S, Chen X, Bai J, Sun Q, Fang H, Qiao J. Tofacitinib Treatment for Pretibial Myxedema. JAMA Dermatol 2024; 160:578-580. [PMID: 38568614 DOI: 10.1001/jamadermatol.2024.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This case report describes tofacitinib treatment for 2 patients with pretibial myxedema.
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Affiliation(s)
- Su Wang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyi Chen
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Juan Bai
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingmiao Sun
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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3
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Tashkandi L, Alsagheir A, Alobaida S, Alhuthil R. Graves' disease thyroid dermopathy: a case report. J Med Case Rep 2024; 18:164. [PMID: 38582878 PMCID: PMC10999074 DOI: 10.1186/s13256-024-04462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 02/13/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Graves' disease is the autoimmune activation of the thyroid gland causing diffuse enlargement and hyperfunction of the gland. Manifestations of Graves' disease are multisystemic and include thyroid orbitopathy; pretibial myxedema, also referred to as thyroid dermopathy; and thyroid acropachy, described as a severe form of thyroid dermopathy. Our paper focuses on an atypical case of thyroid dermopathy. CASE PRESENTATION An 11-year-old Saudi male presented with a prominent diffuse goiter and exophthalmos. Investigations were consistent with a diagnosis of Graves' disease. The physical exam showed diffuse, non-pitting swelling of the ankle and penis, mimicking a lymphatic malformation. Further, multiple nodules were found on the hands and feet. Treatment of the nodules with cautery resulted in more severe nodules. CONCLUSION This report describes rare presentations of thyroid dermopathy mimicking lymphatic malformation. The Koebner phenomenon can explain this patient's atypical presentations. Intralesional injections of triamcinolone and total thyroidectomy showed clear improvement.
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Affiliation(s)
- Loay Tashkandi
- King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
| | - Afaf Alsagheir
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, 11211, Riyadh, Saudi Arabia.
| | - Saud Alobaida
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
| | - Raghad Alhuthil
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, 11211, Riyadh, Saudi Arabia
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4
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Nguyen VB, Nguyen VVH, Van Le C, Linh PNT, Thi XN, Vo TT. Pretibial myxedema in Grave's disease: A case report and treatment review of the literature. Clin Case Rep 2024; 12:e8478. [PMID: 38389965 PMCID: PMC10883341 DOI: 10.1002/ccr3.8478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 02/24/2024] Open
Abstract
Key Clinical Message Pretibial myxedema is a rare skin lesion in Grave's disease, which required topical glucocorticoid administration in long-term treatment. The patient's lesion has shrunk and become flatter than before treatment. Abstract We present a case of biopsy-verified pretibial myxedema in a 70-year-old male patient with diagnosed hyperthyroidism and no prior history of Graves' disease. Topical corticosteroid and antithyroid drug administration led to successful resolution of the skin lesions. This case emphasizes the importance of considering pretibial myxedema even in atypical presentations of Graves' disease and underscores the value of prompt treatment.
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Affiliation(s)
- Van Bang Nguyen
- Center of Endocrinology and Diabetes Family Hospital Da Nang Vietnam
| | - Van Vy Hau Nguyen
- Center of Endocrinology and Diabetes Family Hospital Da Nang Vietnam
| | - Chi Van Le
- Internal Medicine Department, Hue University of Medicine and Pharmacy Hue University Hue City Vietnam
| | | | - Xuan Nguyen Thi
- Center of Endocrinology and Diabetes Family Hospital Da Nang Vietnam
| | - Thanh Trang Vo
- Center of Endocrinology and Diabetes Family Hospital Da Nang Vietnam
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5
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Cerroni L, Rongioletti F. Nodular-Type Lichen Myxedematosus: A Rare Variant With Exclusive Involvement of the Hands-Report of Two Cases With a Comprehensive Review of the Literature. Am J Dermatopathol 2024; 46:36-39. [PMID: 37982501 DOI: 10.1097/dad.0000000000002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
ABSTRACT Lichen myxedematosus (LM) is an uncommon cutaneous mucinosis characterized by the deposition of mucin and fibroblast proliferation in the dermis. This condition can be classified into 2 forms: a diffuse/generalized LM, also known as scleromyxedema, associated with monoclonal gammopathy and systemic implications, and a localized form, primarily affecting the skin. Within the localized form, nodular-type LM is a rare variant presenting as firm, skin-colored to pinkish mucinous nodules. In this article, we report 2 new cases of nodular-type LM with exclusive involvement of the hands and provide a comprehensive review of the diagnosis, histopathological aspects, and therapeutic considerations of this rare condition.
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Affiliation(s)
- Lorenzo Cerroni
- Department of Dermatology, Research Unit of Dermatopathology, Medical University of Graz, Graz, Austria; and
| | - Franco Rongioletti
- Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milano, Italy
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6
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Lebreton O, Seddiki R, Abba S, Vignes S. [Pretibial myxedema after Graves' disease: A differential diagnosis of lymphedema]. Rev Med Interne 2023; 44:641-645. [PMID: 37827928 DOI: 10.1016/j.revmed.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Pretibial myxedema is a rare manifestation of Graves' disease, and pseudotumoral forms may be confused with lower limb lymphedema. OBSERVATIONS We reported 3 cases of pretibial myxedema in 2 women and 1 man, aged 72, 66, and 49 years, treated for Graves' disease 3, 25 and 32 years previously. Two patients were active smokers. Lymphedema diagnosis of the lower limbs was suspected in the presence of bilateral pseudotumoral lesions of the feet, toes and ankles and the presence of a Stemmer's sign (skin thickening at the base of the 2nd toe, pathognomonic of lymphedema). Lymphoscintigraphy in one case was normal, not confirming lymphedema. CONCLUSION Pretibial pseudotumoral myxedema is a differential diagnosis of lower limb lymphedema. This diagnosis is confirmed by questioning the patient about preexisting Graves' disease, the underlying etiology, to decide the appropriate treatment and to encourage cessation of smoking, which is a risk factor for pretibial myxedema.
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Affiliation(s)
- O Lebreton
- Unité de lymphologie, site constitutif du centre national de référence des lymphœdèmes primaires, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - R Seddiki
- Unité de lymphologie, site constitutif du centre national de référence des lymphœdèmes primaires, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - S Abba
- Unité de lymphologie, site constitutif du centre national de référence des lymphœdèmes primaires, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - S Vignes
- Unité de lymphologie, site constitutif du centre national de référence des lymphœdèmes primaires, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
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7
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Branstetter RM, Islam RK, Toups CA, Parra AN, Lee Z, Ahmadzadeh S, Varrassi G, Shekoohi S, Kaye AD. Mechanisms and Treatment Options for Hyperthyroid-Induced Osteoporosis: A Narrative Review. Cureus 2023; 15:e48798. [PMID: 38098934 PMCID: PMC10720926 DOI: 10.7759/cureus.48798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Normal thyroid hormone levels are crucial for the homeostasis of many metabolic cycles and processes throughout the human body. Thyroid dysfunction, such as thyrotoxicosis, can result from many different etiologies, including Graves' disease (GD), toxic multinodular goiter (MNG), and toxic adenoma. These hyperthyroid disease states can cause devastating complications and disease, including the disruption of the bone remodeling cycle and skeletal development, which can result in osteoporosis. Osteoporosis is characterized by a decrease in bone mineral density and a propensity for fragility fractures. In addition to patients with overt hyperthyroidism, studies have provided evidence of other high-risk patient demographics, such as individuals with subclinical hyperthyroidism and postmenopausal women, who may be at an increased risk for the development of secondary osteoporosis. The treatment of patients with hyperthyroid-induced osteoporosis often requires a multifaceted management plan that may be unique to each patient's situation. Antithyroid therapy is often the first step in treating this disease and may include thioamide medications. Radioactive iodine-131 therapy (RAI) and the surgical removal of the thyroid gland may also be reasonable approaches for restoring normal thyroid function. Following thyrotoxicosis mitigation, antiresorptive drugs such as bisphosphonates, calcitonin, and selective estrogen receptor modulators (SERMs) may be used to counteract decreased bone mineral density (BMD). Additionally, the implementation of vitamin D, calcium supplements, and weight-bearing exercise may also reduce bone loss. While the effects of thyroid stimulating hormone (TSH) and triiodothyronine (T3) on bone remodeling have been studied in the past, more research is needed to identify unknown mechanisms and develop future improved treatments for this condition.
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Affiliation(s)
- Robert M Branstetter
- School of Medicine, Louisiana State University Health School of Medicine, New Orleans, USA
| | - Rahib K Islam
- School of Medicine, Louisiana State University Health School of Medicine, New Orleans, USA
| | - Collin A Toups
- School of Medicine, Louisiana State University Health School of Medicine, New Orleans, USA
| | - Amanda N Parra
- School of Medicine, Ross University School of Medicine, Miramar, USA
| | - Zachary Lee
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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8
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Перепелова МА, Зайцева ЕЛ, Бессмертная ЕГ, Груша ЯО, Свириденко НЮ, Галстян ГР. [An integrated approach to the treatment of pretibial myxedema based on pulse therapy with prednisolone and electrical neuromyostimulation (FREMS-therapy) in a patient with Graves' disease and thyroid eye disease]. PROBLEMY ENDOKRINOLOGII 2023; 69:32-37. [PMID: 37694865 PMCID: PMC10520899 DOI: 10.14341/probl12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 09/12/2023]
Abstract
Graves' disease (GD) is one of the urgent problems of modern endocrinology, characterized by a high frequency, polysystemic damage to the body, a steadily progressive course, diagnostic difficulties, a high degree of disability and often resistance to therapy. The manifestations of the disease include: thyrotoxicosis syndrome with impaired lipid and carbohydrate metabolism, and activation of multiple organ pathology in the form of thyroid eye disease (TED), pretibial myxedema, cardiovascular insufficiency, acropathy, lesions of the nervous, osteoarticular system, and other lesions. The development of multiple organ pathology can have a different sequence, different time intervals and different degrees of severity. Any developments in the direction of clarifying the etiopathogenetic, clinical diagnostic and treatment-rehabilitation measures are of undoubted significance. We present a clinical case of GD, TED and pretibial myxedema, in which an integrated approach was tested in the tactics of treating pretibial myxedema (a combination of pulse therapy with prednisolone and FREMS-therapy), as a result of which positive results were obtained within a short time.
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Affiliation(s)
| | - Е. Л. Зайцева
- Национальный медицинский исследовательский центр эндокринологии
| | | | - Я. О. Груша
- Научно-исследовательский институт глазных болезней им. М.М. Краснова
| | | | - Г. Р. Галстян
- Национальный медицинский исследовательский центр эндокринологии
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9
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Chen M, Ge S, Driscoll M. Pretibial myxedema in a patient with HIV and hypothyroid to hyperthyroid transformation. JAAD Case Rep 2023; 36:75-77. [PMID: 37255864 PMCID: PMC10225818 DOI: 10.1016/j.jdcr.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
| | - Shealinna Ge
- Correspondence to: Shealinna Ge, MD, University of Maryland School of Medicine, Department of Dermatology, 419 W Redwood Street, Suite 235, Baltimore, MD 21201.
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10
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Mayrovitz HN, Aoki KC, Colon J. Chronic Venous Insufficiency With Emphasis on the Geriatric Population. Cureus 2023; 15:e40687. [PMID: 37485203 PMCID: PMC10358300 DOI: 10.7759/cureus.40687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
The underpinning of Chronic Venous Insufficiency (CVI) is valvular dysfunction, which manifests on a spectrum depending on the severity of insufficiency and duration of the disease. The mainstay of treatment relies on compression therapy of a proper type and intensity. In older adults, special consideration must be taken during the patient encounter to account for age-related factors. This review discusses the clinical presentation, diagnosis, and mimicking of CVI, focusing mainly on older adults. The epidemiology, risk factors, disease burden, and grave complications -- such as thrombosis and ulceration, are reviewed. The physiological impacts of CVI are described, providing the background for treatment strategies, including non-invasive, medical, and surgical therapies. The findings show advanced age to be an important risk factor contributing to CVI and that other age-related factors add to the risk of severe complications. Clinical assessments combined with objective measurements that assess localized skin water using tissue dielectric constant values or whole limb assessments may aid in the differential diagnosis. Furthermore, understanding the mechanism of action of compression therapy, the mainstay of CVI treatment, and its physiological impacts, allows for its informed use in geriatric patients with increased risks of potential compression-related side effects.
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Affiliation(s)
- Harvey N Mayrovitz
- Medical Education and Simulation, Nova Southeastern University's Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
| | - Kawaiola C Aoki
- Medicine, Nova Southeastern University's Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Jessica Colon
- Medicine, Nova Southeastern University's Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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11
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Angwin C, Zschocke J, Kammin T, Björck E, Bowen J, Brady AF, Burns H, Cummings C, Gardner R, Ghali N, Gröbner R, Harris J, Higgins M, Johnson D, Lepperdinger U, Milnes D, Pope FM, Sehra R, Kapferer-Seebacher I, Sobey G, Van Dijk FS. Non-oral manifestations in adults with a clinical and molecularly confirmed diagnosis of periodontal Ehlers-Danlos syndrome. Front Genet 2023; 14:1136339. [PMID: 37323685 PMCID: PMC10264792 DOI: 10.3389/fgene.2023.1136339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/03/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: Periodontal Ehlers-Danlos Syndrome (pEDS) is a rare autosomal dominant type of EDS characterised by severe early-onset periodontitis, lack of attached gingiva, pretibial plaques, joint hypermobility and skin hyperextensibility as per the 2017 International EDS Classification. In 2016, deleterious pathogenic heterozygous variants were identified in C1R and C1S, which encode components of the complement system. Materials and Methods: Individuals with a clinical suspicion of pEDS were clinically and molecularly assessed through the National EDS Service in London and Sheffield and in genetic services in Austria, Sweden and Australia. Transmission electron microscopy and fibroblast studies were performed in a small subset of patients. Results: A total of 21 adults from 12 families were clinically and molecularly diagnosed with pEDS, with C1R variants in all families. The age at molecular diagnosis ranged from 21-73 years (mean 45 years), male: female ratio 5:16. Features of easy bruising (90%), pretibial plaques (81%), skin fragility (71%), joint hypermobility (24%) and vocal changes (38%) were identified as well as leukodystrophy in 89% of those imaged. Discussion: This cohort highlights the clinical features of pEDS in adults and contributes several important additional clinical features as well as novel deleterious variants to current knowledge. Hypothetical pathogenic mechanisms which may help to progress understanding and management of pEDS are also discussed.
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Affiliation(s)
- C. Angwin
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - J. Zschocke
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - T. Kammin
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - E. Björck
- Clinical Genetics, Karolinska University Hospital, Solna, Sweden
| | - J. Bowen
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - A. F. Brady
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - H. Burns
- Department Otolaryngology Head and Neck Surgery, Children’s Health QLD, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - C. Cummings
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - R. Gardner
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - N. Ghali
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - R. Gröbner
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - J. Harris
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - M. Higgins
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - D. Johnson
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - U. Lepperdinger
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - D. Milnes
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - F. M. Pope
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - R. Sehra
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - I. Kapferer-Seebacher
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - G. Sobey
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - F. S. Van Dijk
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
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12
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Cohen B, Cadesky A, Jaggi S. Dermatologic manifestations of thyroid disease: a literature review. Front Endocrinol (Lausanne) 2023; 14:1167890. [PMID: 37251685 PMCID: PMC10214500 DOI: 10.3389/fendo.2023.1167890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/07/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Thyroid hormone is considered one of the key regulatory hormones for skin homeostasis. Multiple organs are affected by the release of peripheral thyroid hormones (T4 and T3) further regulating various functions at a cellular level. Specifically, skin is considered an important target organ in which the thyroid hormone has a significant impact. Multiple skin diseases are associated with thyroid hormone dysregulation. However, other striking dermatologic manifestations are seen in nails and hair as well. Hypothyroidism, hyperthyroidism, and thyroid cancer can have an array of cutaneous manifestations, and we present the recent updates in this field. Methods A PubMed search was performed for updates in any new skin disease findings and treatments between 2010 and 2022. Research published in the past decade and previously known foundational skin findings associated with thyroid disease were presented in this review. Conclusion Cutaneous manifestations of thyroid disease is one of the first notable signs of thyroid hormone dysregulation. This article reviews the recent updates on the thyroid and skin interplay, and it further discusses overt visible findings and various available treatment modalities.
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13
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Ugradar S, Goldberg RA, Douglas RS. Changing the face of thyroid eye disease. Eye (Lond) 2023; 37:197-199. [PMID: 35882983 PMCID: PMC9873613 DOI: 10.1038/s41433-022-02186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Shoaib Ugradar
- grid.19006.3e0000 0000 9632 6718The Jules Stein Eye Institute University of California, Los Angeles, CA USA
| | - Robert A. Goldberg
- grid.19006.3e0000 0000 9632 6718The Jules Stein Eye Institute University of California, Los Angeles, CA USA
| | - Raymond S. Douglas
- grid.50956.3f0000 0001 2152 9905Cedars-Sinai Medical Center, Los Angeles, CA USA
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14
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Dwivedi SN, Kalaria T, Buch H. Thyroid autoantibodies. J Clin Pathol 2023; 76:19-28. [PMID: 36270794 DOI: 10.1136/jcp-2022-208290] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/24/2022] [Indexed: 12/26/2022]
Abstract
Thyroid-stimulating hormone (TSH) receptor antibody (TSH-R-Ab or TRAb) testing plays a pivotal role in arriving at the aetiological diagnosis in patients with thyrotoxicosis. A positive test establishes the diagnosis of Graves' disease (GD) while a negative result in conjunction with imaging studies supports other possible aetiologies. In patients with GD, TRAb levels at diagnosis and at the time of withdrawal of antithyroid drugs can identify patients who are unlikely to achieve remission and guide clinical management decisions. We provide an algorithm that incorporates TRAb in the decision-making process for the management of thyrotoxicosis. The utility of TRAb in predicting the risk of fetal and neonatal thyroid dysfunction is established and widely accepted in guidelines. TRAb may also help in the diagnosis of Graves' orbitopathy, especially in euthyroid or hypothyroid patients and its role in guiding its management is evolving as a useful adjunct to the clinical parameters used in making therapeutic decisions.Anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TgAb) indicate thyroid autoimmunity. The most common use of TPOAb is to identify patients at a higher risk of progression to treatment-requiring hypothyroidism. They also aid the diagnosis of immune thyroiditis and Hashimoto's encephalopathy. Thyroglobulin measurement is used to help guide differentiated thyroid cancer treatment. TgAb is used as an accompanying test with thyroglobulin measurement as its presence can interfere with the thyroglobulin assay. A negative TgAb result reduces the likelihood of, but does not exclude, interference with thyroglobulin assay.
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Affiliation(s)
| | - Tejas Kalaria
- Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Wolverhampton, UK
| | - Harit Buch
- Endocrinology and Diabetes, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
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15
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Reyes MP, Cabrera J, Singh J, Turnbull D. Teprotumumab for Treatment of Pretibial Myxedema. JCEM CASE REPORTS 2023; 1:luac037. [PMID: 37908268 PMCID: PMC10578414 DOI: 10.1210/jcemcr/luac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 11/02/2023]
Abstract
Pretibial myxedema (PTM), also called thyroid dermopathy, is a dreaded and potentially debilitating manifestation of thyroid disease, more commonly Graves' disease, which can occur at any time over the course of the disease. No substantial long-term therapies have been able to target the condition, and management has typically been supportive (eg, compression socks, weight loss), with courses of moderate-intensity steroids. Teprotumumab has been approved for the management of thyroid eye disease (TED), and it is believed that the 2 share a similar pathophysiology likely related to type 1 insulin-like growth factor receptor, which may explain why some patients have also experienced improvement in PTM. Here we present a patient who received 8 doses of teprotumumab for TED who, over the course of management and into follow-up, experienced significant improvement in her pretibial myxedema. The patient noted considerable improvement in quality of life and ability to perform daily activities. We present this case to consider further investigation into the utilization of teprotumumab for thyroid disease-related PTM in patients with impaired quality of life.
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Affiliation(s)
| | - John Cabrera
- Sierra View Medical Center, Porterville, California 93257, USA
| | - Jasvir Singh
- Sierra View Medical Center, Porterville, California 93257, USA
| | - Dennis Turnbull
- Sierra View Medical Center, Porterville, California 93257, USA
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16
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Bocheva G, Malinova L, Bakalov D, Bogdanov G, Hristova J, Svinarov D. Inhibitory effect of pentoxifylline on the synthesis and deposition of glycosaminoglycans in hypothyroid skin. BIOTECHNOL BIOTEC EQ 2022. [DOI: 10.1080/13102818.2022.2116998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Georgeta Bocheva
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Lina Malinova
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Dimitar Bakalov
- Department of Physiology and Pathophysiology, Faculty of Medicine, Sofia Medical University, Sofia, Bulgaria
| | - Georgi Bogdanov
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Julieta Hristova
- Department of Clinical Laboratory & Clinical Pharmacology, Alexander Hospital, Faculty of Medicine, Sofia Medical University, Sofia, Bulgaria
| | - Dobrin Svinarov
- Department of Clinical Laboratory & Clinical Pharmacology, Alexander Hospital, Faculty of Medicine, Sofia Medical University, Sofia, Bulgaria
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17
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Bowens BK, Chou E, LaChance DP, Huynh JR, Voorhees P, Do TC, Shakir MKM, Hoang TD. Graves' disease complicated by concurrent thyroid eye disease and pretibial myxedema successfully treated with teprotumumab. Clin Case Rep 2022; 10:e6621. [PMID: 36415714 PMCID: PMC9675368 DOI: 10.1002/ccr3.6621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/08/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2022] Open
Abstract
We report a 51‐year‐old woman with thyroid eye disease and biopsy‐proven pretibial myxedema that was subsequently treated with teprotumumab with improvement.
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Affiliation(s)
- Brendan K. Bowens
- Department of Medicine Dwight D. Eisenhower Army Medical Center Augusta Georgia USA
| | - Eva Chou
- Department of Ophthalmology Walter Reed National Military Medical Center Bethesda Maryland USA
| | - David P. LaChance
- Department of Medicine Dwight D. Eisenhower Army Medical Center Augusta Georgia USA
- Division of Endocrinology, Department of Medicine Uniformed Service University of the Health Sciences Bethesda Maryland USA
| | - James R. Huynh
- Department of Medicine Dwight D. Eisenhower Army Medical Center Augusta Georgia USA
| | - Patrick Voorhees
- Department of Pathology Walter Reed National Military Medical Center Bethesda Maryland USA
| | - Thanh C. Do
- Division of Endocrinology, Department of Medicine Uniformed Service University of the Health Sciences Bethesda Maryland USA
| | - Mohamed K. M. Shakir
- Division of Endocrinology, Department of Medicine Uniformed Service University of the Health Sciences Bethesda Maryland USA
- Division of Endocrinology, Department of Medicine Walter Reed National Military Medical Center Bethesda Maryland USA
| | - Thanh D. Hoang
- Division of Endocrinology, Department of Medicine Uniformed Service University of the Health Sciences Bethesda Maryland USA
- Division of Endocrinology, Department of Medicine Walter Reed National Military Medical Center Bethesda Maryland USA
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18
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Hathi D, Goswami S, Sengupta N, Baidya A, Gaikwad PM, Das N, Tarenia SS, Oswal R. A Case of Elephantiasic Pretibial Myxedema Successfully Treated With Intralesional Triamcinolone Acetate. Cureus 2022; 14:e29234. [PMID: 36259012 PMCID: PMC9573773 DOI: 10.7759/cureus.29234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/19/2022] Open
Abstract
Graves' dermopathy is one of the extra-thyroidal manifestations of Graves’ disease (GD) and is characterized by the accumulation of glycosaminoglycans in the reticular dermis. In the majority of cases, pretibial myxedema is self-limiting but, in some cases, it can lead to structural and functional damage. Topical steroids with occlusive dressing remain the conventional treatment, but intralesional steroids have shown promising results. We hereby present a case of pretibial myxedema treated successfully with intralesional triamcinolone acetate.
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Weare-Regales N, Chiarella SE, Cardet JC, Prakash YS, Lockey RF. Hormonal Effects on Asthma, Rhinitis, and Eczema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2066-2073. [PMID: 35436605 PMCID: PMC9392967 DOI: 10.1016/j.jaip.2022.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/18/2022] [Accepted: 04/02/2022] [Indexed: 05/03/2023]
Abstract
Hormones significantly influence the pathogenesis of asthma, rhinitis, and eczema. This review aims to summarize relevant clinical considerations for practicing allergists and immunologists. The first section reviews the effects of sex hormones: estrogen, progesterone, and testosterone. The second concerns insulin production in the context of type 1 and type 2 diabetes. The third concludes with a discussion of thyroid and adrenal pathology in relationship to asthma, rhinitis, and eczema.
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Affiliation(s)
- Natalia Weare-Regales
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla; Division of Endocrinology, Department of Internal Medicine, James A. Haley Veterans Administration, Tampa, Fla.
| | - Sergio E Chiarella
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
| | - Y S Prakash
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minn; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minn
| | - Richard F Lockey
- Division of Endocrinology, Department of Internal Medicine, James A. Haley Veterans Administration, Tampa, Fla; Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
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20
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Mervis JS, Maeng MM, Kirsner RS, Wester ST. Teprotumumab as a novel treatment for pretibial myxedema. Br J Dermatol 2022; 187:795-797. [PMID: 35665912 DOI: 10.1111/bjd.21700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Joshua S Mervis
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michelle M Maeng
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert S Kirsner
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sara T Wester
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
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21
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Dauguet M, Abba S, Lebrun-Vignes B, Vignes S. Des lésions végétantes des jambes. Rev Med Interne 2022; 43:450-451. [DOI: 10.1016/j.revmed.2022.03.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
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22
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Crespo-Trevino R, Schiffman J, Ugradar S, Cockerham K, Douglas R, de Leon-Garza D, Tang R. Thyroid dermopathy responds to teprotumumab therapy. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0201. [PMID: 35319490 PMCID: PMC9002184 DOI: 10.1530/edm-21-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Summary Thyroid dermopathy is an uncommon manifestation of thyroid disease that impairs the quality of life in certain cases. Currently, the available treatments offer limited results and a chance of recurrence. Teprotumumab, a novel medication that results in the regression of thyroid ophthalmopathy, may have similar effects on dermopathy. We describe four patients treated with teprotumumab for their thyroid ophthalmopathy who concomitantly had dermatopathy upon initiation of their infusions. Patients improved after two to three infusions and three out of the four patients have not suffered a recurrence.Teprotumumab is a monoclonal antibody (MAB) that attenuates an inflammatory response, resulting in decreased edema and tissue expansion. Given the similarities of their pathophysiology, we believe that the resolution of thyroid dermatopathy and regression of thyroid eye disease occurs via the same mechanism. We encourage further investigation utilizing teprotumumab for patients whose dermopathy is associated with impaired quality of life. Learning points Thyroid dermopathy (TD), an uncommon manifestation of thyroid disease, may occasionally impair function and quality of life. There are only a few treatments for TD, with limited results and high rates of recurrence. Teprotumumab is a Food and Drug Administration-approved medication used for thyroid eye disease (TED). Our patients treated with teprotumumab for TED showed improvement of TD, which demonstrates its potential use for this condition.
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Affiliation(s)
- Ricaurte Crespo-Trevino
- Universidad de Monterrey, Monterrey, Mexico
- Neuro-Ophthalmology of Texas, and Neuro-Eye Clinical Trials Inc., Houston, Texas, USA
| | - Jade Schiffman
- Neuro-Ophthalmology of Texas, and Neuro-Eye Clinical Trials Inc., Houston, Texas, USA
| | - Shoaib Ugradar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kimberly Cockerham
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Raymond Douglas
- The Jules Stein Eye Institute University of California, Los Angeles, California, USA
| | | | - Rosa Tang
- Neuro-Ophthalmology of Texas, and Neuro-Eye Clinical Trials Inc., Houston, Texas, USA
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23
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Pinhas A, Andrade Romo JS, Lynch G, Zhou DB, Castanos Toral MV, Tenzel PA, Otero-Marquez O, Yakubova S, Barash A, Della Rocca D, Della Rocca R, Chui TYP, Rosen RB, Reddy HS. A Pilot Study of Subclinical Non-Capillary Peripapillary Perfusion Changes in Thyroid-Related Orbitopathy Detected Using Optical Coherence Tomography Angiography. Clin Ophthalmol 2022; 16:867-875. [PMID: 35340669 PMCID: PMC8948173 DOI: 10.2147/opth.s356631] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/25/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose Hemodynamic changes surrounding the optic nerve head are known to occur in thyroid-related orbitopathy (TRO). This pilot study explores the capillary and non-capillary peripapillary perfusion changes of the retina in TRO eyes without dysthyroid optic neuropathy (DON) using optical coherence tomography angiography (OCT-A). Methods Non-capillary and capillary peripapillary perfusion densities were calculated using single 4.5 × 4.5mm en face “RPC layer” OCT-A scans of 8 TRO patients without DON (8 eyes, mean age 40.6 years, range 23–69 years). Results were compared to a previously published dataset of 133 healthy controls (133 eyes, mean 41.5 years, range 11–83 years). The strength of association was measured between OCT-A perfusion densities and clinical measures of TRO. Results Non-capillary peripapillary perfusion density in TRO eyes was found to be significantly decreased compared to healthy controls (TRO group 15.4 ± 2.9% vs controls 21.5 ± 3.1%; p < 0.0001). Capillary peripapillary perfusion densities showed no significant difference (TRO group 42.5 ± 1.8% vs controls 42.5 ± 1.5%; p = 1.0). Clinical measures of disease did not correlate well with OCT-A perfusion densities (p>0.05). Conclusion These findings may represent decreased blood flow and subclinical ischemia to the optic nerve. We discuss possible pathogenic mechanisms of thyroid-related vasculopathy, including vessel wall thickening due to immunologically-induced media enlargement.
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Affiliation(s)
- Alexander Pinhas
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Department of Ophthalmology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Jorge S Andrade Romo
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Giselle Lynch
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davis B Zhou
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria V Castanos Toral
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Phillip A Tenzel
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Oscar Otero-Marquez
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Shoshana Yakubova
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Department of Biology, Macaulay Honors College at City University of New York Queens College, Flushing, NY, USA
| | - Alexander Barash
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - David Della Rocca
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Robert Della Rocca
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Toco Y P Chui
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Richard B Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Harsha S Reddy
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Correspondence: Harsha S Reddy, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA, Tel +1 212-979-4284, Fax +1 212-966-6295, Email
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24
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De Novo Extra-Thyroidal Manifestations of Graves' Disease presenting 16 Years after Total Thyroidectomy for Thyroid Cancer. J ASEAN Fed Endocr Soc 2021; 36:216-219. [PMID: 34966209 PMCID: PMC8666488 DOI: 10.15605/jafes.036.02.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/10/2021] [Indexed: 11/17/2022] Open
Abstract
We present a 61-year-old Chinese female who had a history of angioinvasive follicular thyroid cancer (FTC) treated with total thyroidectomy 16 years ago, without radioactive iodine (RAI) treatment who now presents with de novo pretibial myxedema (PTM) followed by active severe Graves’ ophthalmopathy (GO) requiring pulse steroids and radiotherapy.
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25
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Gubbi S, Araque KA, Avadhanula S, Azam A, Merkel R, Cochran C, Burbelo PD, Waldman M, Neumann S, Gershengorn MC, Skarulis M, Klubo-Gwiezdzinska J. Combined Immunosuppressive Therapy for Severe Graves Dermopathy. Ann Intern Med 2021; 174:1478-1480. [PMID: 34152827 PMCID: PMC9473454 DOI: 10.7326/l21-0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sriram Gubbi
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Katherine Andrea Araque
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Asma Azam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Roxanne Merkel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Craig Cochran
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Peter Denis Burbelo
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Meryl Waldman
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Susanne Neumann
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Marvin Carl Gershengorn
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Monica Skarulis
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Mir SUI, Laway BA. Elephantiatic Graves' Dermopathy Successfully Treated with Intralesional Steriod. Indian J Endocrinol Metab 2021; 25:471-472. [PMID: 35300437 PMCID: PMC8923328 DOI: 10.4103/ijem.ijem_367_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sajad Ul Islam. Mir
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Bashir A. Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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27
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Du T, Jiang W, Luo H, Chen F, Yuan G, Zhang M, Liu Z. Bilateral breast myxedema caused by Graves' disease and responsive to multipoint subcutaneous injection of long-acting glucocorticoid: Case report. Medicine (Baltimore) 2021; 100:e26469. [PMID: 34160454 PMCID: PMC8238392 DOI: 10.1097/md.0000000000026469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE With the absence of ophthalmopathy, thyroid dermopathy especially lesions at atypical locations is a very rare presentation. We herein report an original case of bilateral breast myxedema caused by Grave's disease. PATIENT CONCERNS A 21-year-old unmarried woman presented with a 4-month history of Grave's disease and a 1-month history of progressive bilateral breast enlargement. She had symmetrical bilateral breast enlargement with redness and nonpitting thickening of the skin, diffusely enlarged thyroid glands, and no exophthalmos. DIAGNOSIS Ultrasonography, magnetic resonance imaging scan, and skin biopsy confirmed the diagnosis of bilateral breast myxedema. INTERVENTIONS The patient was treated with multipoint subcutaneous injections of triamcinolone acetonide in each breast every month. OUTCOMES The bilateral breast returned approximately to its normal size after therapy for 6 months. CONCLUSIONS Our case illustrates that multipoint subcutaneous injection of glucocorticoids is beneficial for bilateral breast myxedema.
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Affiliation(s)
- Tingting Du
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, Branch of National Clinical Research Center for Metabolic Disease, Hubei
| | - Wangyan Jiang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, Branch of National Clinical Research Center for Metabolic Disease, Hubei
| | - Hongchang Luo
- Department of Ultrasonography, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fuqiong Chen
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, Branch of National Clinical Research Center for Metabolic Disease, Hubei
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, Branch of National Clinical Research Center for Metabolic Disease, Hubei
| | - Muxun Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, Branch of National Clinical Research Center for Metabolic Disease, Hubei
| | - Zhelong Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, Branch of National Clinical Research Center for Metabolic Disease, Hubei
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Insidious-Onset Indurated Plaques on the Shins. Dermatopathology (Basel) 2021; 8:185-189. [PMID: 34204035 PMCID: PMC8293184 DOI: 10.3390/dermatopathology8020024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/17/2022] Open
Abstract
A 64-year old male presented with a several-year history of an insidious-onset tender, itchy and xerotic rash on his lower legs. Past medical history was significant for Graves’ disease and Graves’ ophthalmopathy. The examination revealed peau d’orange-appearing plaques on his shins clinically consistent with pretibial myxedema. A punch biopsy showed separation of collagen bundles with extensive dermal mucin deposition, confirming the diagnosis of pretibial myxedema. After initially failing treatment with a topical clobetasol 0.05% ointment, the patient switched to regular pentoxifylline and triamcinolone 0.1% ointment under occlusion. He remains under follow-up.
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29
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Chen X, Dong J, Zhang L, Zhao X, Shi R, Pan M, Zheng J. Local immune microenvironment of skin may play an important role in the development of pretibial myxedema. Exp Dermatol 2021; 30:1820-1824. [PMID: 34047397 PMCID: PMC8597019 DOI: 10.1111/exd.14402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/02/2021] [Accepted: 05/20/2021] [Indexed: 01/26/2023]
Abstract
Pretibial myxedema (PTM), characterized by the accumulation of glycosaminoglycans in dermis is an autoimmune skin disorder, which is almost always associated with Graves’ disease (GD). Although fibroblast stimulated by thyroid‐stimulating hormone receptor (TSHR) antibody, cytokines and growth factors have been postulated as target of the autoimmune process in the dermopathy, the pathogenesis of PTM remains unclear. We hypothesize that the local immune microenvironment of the skin including the antigens and antibodies, T cells, B cells, plasma cells and fibroblasts may play an important role in the development of PTM. Results obtained on PTM patients indicate increased thyroid‐stimulating hormone receptor antibodies (TRAb) in the blood positively correlate with the dermal thickness of the lesions. Further analysis shows that there were more CD3+ T cells and CD20+ B cells in the skin lesions. These T and B cells are in close contact, indicating that inducible skin‐associated lymphoid tissue (iSALT) may be formed in the area. In addition, we found that the infiltrating plasma cells can secrete TRAb, proving that B cells in the skin other than the thyroid are an additional source of TSHR antibodies. Meanwhile, the T and B cells in the skin or skin homogenate of patients can promote the proliferation of pretibial fibroblasts. In conclusion, our results provide evidence that the local immune microenvironment of the skin may play an important role in the development of PTM.
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Affiliation(s)
- Xiaoying Chen
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoyun Dong
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhang
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoqing Zhao
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruofei Shi
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zheng
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lan C, Hu L, Liao C, Shi Y, Wang Y, Cheng S, Huang W. Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema. J Clin Med Res 2020; 12:711-723. [PMID: 33224373 PMCID: PMC7665869 DOI: 10.14740/jocmr4352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/07/2020] [Indexed: 01/26/2023] Open
Abstract
Background Pretibial myxedema (PTM) is a local mucinous dermopathy associated with thyroid diseases. Since the etiology of PTM is unclear, the aim of this study is to identify the risk factors for PTM and their etiological roles in PTM occurrence. Methods A large-scale case-control study (n = 1,200) was performed to identify risk factors for PTM by calculating odds ratio (OR) values and 95% confidential intervals. The PTM group entered a glucocorticoid treatment trial. Patients with complete response were followed up to the first relapse in a cohort study. The relative risk (RR) values of the main risk factors were calculated for PTM relapse to test their etiological roles. Results Among the 19 factors, six risk factors were identified: thyroid-stimulating hormone (TSH) receptor antibody (TRAb) (OR 42.93), autoimmune thyroid disease (AITD) or AITD history (OR 10.30), local trauma (OR 6.55), venous stasis posture (OR 6.16), cigarette smoking (OR 4.48), and age (OR 1.05). Serum TRAb levels were positively correlated with the severity of PTM. Of note, 371/400 patients received glucocorticoid treatment, and 330 achieved complete response. The serum TRAb levels after treatment decreased dramatically compared with those before treatment. After stopping glucocorticoid treatment, serum TRAb levels increased significantly when PTM relapsed (P < 0.001). In 165 relapse cases, an increase in serum TRAb levels occurred first, followed by persistent venous stasis posture or local trauma and finally PTM. The RR of elevated serum TRAb levels was 6.73 in PTM relapse cases. In the elevated serum TRAb level group, the RRs of local trauma, venous stasis posture, and local trauma plus venous stasis posture were 8.81, 6.5, and 8.84, respectively, for PTM relapse cases. Conclusions TSHR autoimmunity and local factors in the six identified risk factors are the main causes of PTM occurrence.
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Affiliation(s)
- Changgui Lan
- Department of Dermatology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Liping Hu
- Department of Dermatology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Chengqi Liao
- Department of Dermatology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Yuhong Shi
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Yi Wang
- Department of Dermatology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Shuanghua Cheng
- Department of Pathology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Wei Huang
- Department of Health Checkup Center, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
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Davies TF, Andersen S, Latif R, Nagayama Y, Barbesino G, Brito M, Eckstein AK, Stagnaro-Green A, Kahaly GJ. Graves' disease. Nat Rev Dis Primers 2020; 6:52. [PMID: 32616746 DOI: 10.1038/s41572-020-0184-y] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 02/08/2023]
Abstract
Graves' disease (GD) is an autoimmune disease that primarily affects the thyroid gland. It is the most common cause of hyperthyroidism and occurs at all ages but especially in women of reproductive age. Graves' hyperthyroidism is caused by autoantibodies to the thyroid-stimulating hormone receptor (TSHR) that act as agonists and induce excessive thyroid hormone secretion, releasing the thyroid gland from pituitary control. TSHR autoantibodies also underlie Graves' orbitopathy (GO) and pretibial myxoedema. Additionally, the pathophysiology of GO (and likely pretibial myxoedema) involves the synergism of insulin-like growth factor 1 receptor (IGF1R) with TSHR autoantibodies, causing retro-orbital tissue expansion and inflammation. Although the aetiology of GD remains unknown, evidence indicates a strong genetic component combined with random potential environmental insults in an immunologically susceptible individual. The treatment of GD has not changed substantially for many years and remains a choice between antithyroid drugs, radioiodine or surgery. However, antithyroid drug use can cause drug-induced embryopathy in pregnancy, radioiodine therapy can exacerbate GO and surgery can result in hypoparathyroidism or laryngeal nerve damage. Therefore, future studies should focus on improved drug management, and a number of important advances are on the horizon.
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Affiliation(s)
- Terry F Davies
- Thyroid Research Laboratory, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,James J. Peters VA Medical Center, New York, NY, USA. .,Mount Sinai Thyroid Center, Mount Sinai Downtown at Union Sq, New York, NY, USA.
| | - Stig Andersen
- Department of Geriatric and Internal Medicine and Arctic Health Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Rauf Latif
- Thyroid Research Laboratory, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, New York, NY, USA
| | - Yuji Nagayama
- Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Giuseppe Barbesino
- Thyroid Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Maria Brito
- Mount Sinai Thyroid Center, Mount Sinai Downtown at Union Sq, New York, NY, USA
| | - Anja K Eckstein
- Department of Ophthalmology, University Duisburg Essen, Essen, Germany
| | - Alex Stagnaro-Green
- Departments of Medicine, Obstetrics and Gynecology and Medical Education, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Centre, Mainz, Germany
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33
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Der Blick in die Augen …. Z Rheumatol 2020; 79:466-469. [DOI: 10.1007/s00393-020-00787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Menzinger S, Kaya G. Successful Treatment of Scalp Myxedema with Injected Hyaluronidase: A Case Report. Dermatopathology (Basel) 2020; 6:260-265. [PMID: 32232032 PMCID: PMC7098337 DOI: 10.1159/000505354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
Localized myxedema is an uncommon complication of Graves' disease. It is characterized by the accumulation of glycosaminoglycans, particularly hyaluronate. Here we describe the case of a 51-year-old female patient suffering from Graves' disease, who has presented for years a thickening of the scalp, consistent with myxedema, and successfully treated with repeated injections of hyaluronidase.
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Affiliation(s)
- Sébastien Menzinger
- Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland
| | - Gürkan Kaya
- Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland.,Department of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
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Yang J, Dong MJ, Xu Q. Elephantiasic Pretibial Myxedema with Graves' Disease: Spontaneously Induced and Dramatically Resolved after Radioiodine Treatment. Eur Thyroid J 2020; 9:55-56. [PMID: 32071903 PMCID: PMC7024891 DOI: 10.1159/000504217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/18/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | - Qin Xu
- *Qin Xu, Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qing Chun Road, Hangzhou 310003 (PR China), E-Mail
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36
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Singla M, Gupta A. Nodular Thyroid Dermopathy: Not a Hallmark of Graves Disease. Am J Med 2019; 132:e521-e522. [PMID: 30447206 DOI: 10.1016/j.amjmed.2018.11.004] [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: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Mandeep Singla
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India.
| | - Abhinav Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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Zhang F, Lin XY, Chen J, Peng SQ, Shan ZY, Teng WP, Yu XH. Intralesional and topical glucocorticoids for pretibial myxedema: A case report and review of literature. World J Clin Cases 2018; 6:854-861. [PMID: 30510955 PMCID: PMC6265002 DOI: 10.12998/wjcc.v6.i14.854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/04/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
Pretibial myxedema (PTM), an uncommon manifestation of Graves’ disease (GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide (40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient’s PTM achieved complete remission in both legs after an approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for 8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective, and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.
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Affiliation(s)
- Fan Zhang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xin-Yue Lin
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jian Chen
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Shi-Qiao Peng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhong-Yan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wei-Ping Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xiao-Hui Yu
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Kraus CN, Sodha P, Vaidyanathan P, Kirkorian AY. Thyroid dermopathy and acropachy in pediatric patients. Pediatr Dermatol 2018; 35:e371-e374. [PMID: 30187962 DOI: 10.1111/pde.13670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The extrathyroid manifestations of Graves disease (GD) include thyroid orbitopathy, dermopathy, and acropachy. Thyroid dermopathy (TD), also known as pretibial myxedema, classically presents as nonpitting edema or plaquelike lesions on the pretibial region, while thyroid acropachy (TA) is seen in cases of severe TD, characterized by soft tissue swelling and clubbing of fingers and toes, as well as a periosteal reaction of the bones of the hands and feet. Both TD and TA are rare manifestations of thyroid disease and uncommonly reported in pediatric patients. Our aim was to increase awareness of dermatological manifestations associated with pediatric GD and review the literature of pediatric thyroid dermopathy as well as report a case of acropachy in a child.
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Affiliation(s)
- Christina N Kraus
- Department of Dermatology, University of California, Irvine, California
| | - Pooja Sodha
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Priya Vaidyanathan
- Division of Endocrinology, Children's National Health System, Washington, District of Columbia.,George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - A Yasmine Kirkorian
- George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.,Division of Dermatology, Children's National Health System, Washington, District of Columbia
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39
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Hoesly PM, Tolaymat LM, Sluzevich JC, Keeling JH. Pretibial myxedema successfully treated with intralesional hyaluronidase. JAAD Case Rep 2018; 4:874-876. [PMID: 30306115 PMCID: PMC6172446 DOI: 10.1016/j.jdcr.2018.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Paul M. Hoesly
- Correspondence to: Paul M. Hoesly, MD, Department of Dermatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224.
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40
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Lee JH, Park SM, Lew BL, Sim WY. Pretibial Myxedema Presenting as Severe Elephantiasis. Ann Dermatol 2018; 30:592-596. [PMID: 33911484 PMCID: PMC7992468 DOI: 10.5021/ad.2018.30.5.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/16/2022] Open
Abstract
Elephantiasis is a symptom characterized by the thickening of the skin and underlying tissues in the legs. Pretibial myxedema (PTM) is a non-frequent manifestation of autoimmune thyroiditis, particularly Graves' disease. Lesions of myxedema occur most commonly on the pretibial surfaces, also develop at sites of previous injury or scars and other areas. A 49-year-old male presented with severe elephantiasis on the both pretibial areas, dorsum of the feet, ankles and toes. Twenty years previously, he had received radioactive iodine treatment for thyrotoxicosis. Laboratory tests showed that the patient's thyroid function was normal, but the level of thyroid stimulating hormone (TSH) receptor antibodies was very high (>40 IU/L). The biopsy confirmed PTM. Interestingly, the connective tissue was stained with the TSH receptor antibodies in the deep dermis. Elephantiasic PTM is a severe form of the myxedema and there is few reported case. We report a rare case of PTM with appearance of severe elephantiasis.
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Affiliation(s)
- Jae-Hoon Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang-Myung Park
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Woo-Young Sim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
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41
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Anagnostis P, Artzouchaltzi A, Grekou A, Paschou SA, Gerou S, Tzalokostas V. Pretibial myxedema in a euthyroid patient. Hormones (Athens) 2018; 17:133-135. [PMID: 29858862 DOI: 10.1007/s42000-018-0008-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/13/2018] [Indexed: 11/30/2022]
Abstract
Pretibial myxedema (PM) is a rare extrathyroidal manifestation of Graves' disease (GD), usually during the hyperthyroid state, coexisting with orbitopathy. We describe a rare case of a biopsy-proven PM in a euthyroid patient, without history of GD or Hashimoto's thyroiditis. Assessment of commonly reported thyroid autoantibodies, such as thyroid peroxidase and thyroglobulin autoantibodies, thyroid stimulating immunoglobulins and thyroid binding inhibitory immunoglobulins, was negative. Resolution of skin pathology was achieved after topical application of corticosteroids and was sustained 1 year later.
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Affiliation(s)
- Panagiotis Anagnostis
- Division of Endocrinology, Police Medical Center of Thessaloniki, Monastiriou 326, 54121, Thessaloniki, Greece.
| | - Aikaterini Artzouchaltzi
- Division of Endocrinology, Police Medical Center of Thessaloniki, Monastiriou 326, 54121, Thessaloniki, Greece
| | - Alexandra Grekou
- Laboratory of Histopathology "Histodiagnostiki", Thessaloniki, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vasilios Tzalokostas
- Division of Endocrinology, Police Medical Center of Thessaloniki, Monastiriou 326, 54121, Thessaloniki, Greece
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42
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Vannucchi G, Salvi M. Pretibial Myxedema. ENCYCLOPEDIA OF ENDOCRINE DISEASES 2018:707-710. [DOI: 10.1016/b978-0-12-801238-3.65245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Ren Z, He M, Deng F, Chen Y, Chai L, Chen B, Deng W. Treatment of pretibial myxedema with intralesional immunomodulating therapy. Ther Clin Risk Manag 2017; 13:1189-1194. [PMID: 28932121 PMCID: PMC5598751 DOI: 10.2147/tcrm.s143711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Local immune regulation therapy has been one of the therapeutic methods used for the treatment of autoimmune thyroid disease in patients with pretibial myxedema (PTM). However, the poor response rate and high recurrence rate are still major problems. Whether a premixed corticosteroid, compound betamethasone, could enhance remission rate and decrease recurrence rate in patients with PTM was investigated in the present study. Subjects and methods We have performed a clinical utility observation of compound betamethasone with intralesional injections based on basic thyroid disease treatment in 32 PTM patients between January 2008 and August 2016. The patients were followed up for 2 years, and the clinical outcomes and side effects were calculated and analyzed. Results All patients had a complete remission after different times of injection. A total of 21.7% patients had complete remission with one time of injection, 34.8% with two times of injection, 17.4% with three times of injection, 4.3% with four times of injection, and 4.3% with five times of injection. In all, 56.3% patients with a disease duration of <6 months had complete remission after a 1-month treatment, 37.5% patients with a disease duration between 6 months and 12 months had complete remission after a 2-month treatment, 3.1% patients with a disease duration of 2 years had complete remission after a 5-month treatment, and 3.1% with a disease duration of 5 years had complete remission after a 7-month treatment. Conclusion Compound betamethasone with multipoint intralesional injection is a feasible, effective, and secure novel strategy in the treatment of PTM.
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Affiliation(s)
- Ziwei Ren
- Department of Endocrinology and Nephrology, Chongqing Emergency Medical Hospital (The Fourth People's Hospital of Chongqing)
| | - Min He
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Fang Deng
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Yan Chen
- Department of Endocrinology and Nephrology, Chongqing Emergency Medical Hospital (The Fourth People's Hospital of Chongqing)
| | - Liyin Chai
- Department of Endocrinology and Nephrology, Chongqing Emergency Medical Hospital (The Fourth People's Hospital of Chongqing)
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Wuquan Deng
- Department of Endocrinology and Nephrology, Chongqing Emergency Medical Hospital (The Fourth People's Hospital of Chongqing)
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Abstract
Hyperthyroidism is a form of thyrotoxicosis in which there is excess thyroid hormone synthesis and secretion. Multiple etiologies can lead to a common clinical state of "thyrotoxicosis," which is a consequence of the high thyroid hormone levels and their action on different tissues of the body. The most common cause of thyrotoxicosis is Graves' disease, an autoimmune disorder in which stimulating thyrotropin receptor antibodies bind to thyroid stimulating hormone (TSH) receptors on thyroid cells and cause overproduction of thyroid hormones. Other etiologies include: forms of thyroiditis in which inflammation causes release of preformed hormone, following thyroid gland insult that is autoimmune, infectious, mechanical or medication induced; secretion of human chorionic gonadotropin in the setting of transient gestational thyrotoxicosis and trophoblastic tumors; pituitary thyrotropin release, and exposure to extra-thyroidal sources of thyroid hormone that may be endogenous or exogenous. © 2017 American Physiological Society. Compr Physiol 7:67-79, 2017.
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Affiliation(s)
- Ishita Singh
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare Systems, Los Angeles, California, USA
| | - Jerome M Hershman
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare Systems, Los Angeles, California, USA
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45
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Milman LDM, Grill AB, Müller GP, De Villa D, Souza PRM. Pretibial mucinosis in an euthyroid patient. An Bras Dermatol 2016; 91:100-2. [PMID: 26982789 PMCID: PMC4782657 DOI: 10.1590/abd1806-4841.20164043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/13/2014] [Indexed: 11/22/2022] Open
Abstract
A case of exuberant pretibial mucinosis in a patient with normal thyroid function is reported. A review of literature on possible etiologies other than thyroid disease for the accumulation of mucin in the pretibial area is presented. In the patient described, it is possible that vascular insufficiency is involved. However, this is not the only factor responsible for the accumulation of mucin, since there are still unidentified causes and many patients with vascular diseases do not develop similar injuries.
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Affiliation(s)
- Laura de Mattos Milman
- Complexo Hospitalar da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Barcellos Grill
- Complexo Hospitalar da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Giana Paula Müller
- Complexo Hospitalar da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Damiê De Villa
- Complexo Hospitalar da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Morphological Diversity of Pretibial Myxedema and Its Mechanism of Evolving Process and Outcome: A Retrospective Study of 216 Cases. J Thyroid Res 2016; 2016:2652174. [PMID: 27648339 PMCID: PMC5014960 DOI: 10.1155/2016/2652174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/19/2016] [Accepted: 07/14/2016] [Indexed: 12/11/2022] Open
Abstract
Background. Pretibial myxedema (PTM) is a rare dermopathy. The morphologic features and mechanism of its evolving process are not reported in large case series. Methods. 216 cases with PTM were retrospectively reviewed to analyze demographics, history, lesional morphology and its evolving process, histopathology and immunohistochemistry, serum TRAb levels, treatment, and outcome. Results. First appearing lesions evolved into 6 variants that were correlated with serum TRAb levels. Subvariants were caused by different kinds and frequencies of local trauma. The evolving process could be classified into 4 stages that were correlated with serum TRAb levels and perivascular infiltration of CD8+ and CD4+ lymphocytes. Serum TRAb levels at remission and in nonrecurred cases became lower than those before therapy and in recurred cases, respectively, but increased when PTM relapsed. TRAb level in nodule variant went down invariably with the extension of course and its autoimmune activity had a trend to stop but in other 5 variants TRAb levels fluctuated. Their autoimmune activities had no trends to stop and clinically worsen through intermittent repeats of active and stable stages. Conclusions. In the chronic course of PTM, nodule variant is self-limited and other 5 variants are not self-limited. PTM needed early treatment to avoid severe variants.
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Menzinger S, Kaya A, Saurat JH, Kaya G. Injected Hyaluronidase Reduces the Volume of Exogenous Hyaluronate Fillers in Mice and Results in Clinical Improvement in a Patient with Pretibial Myxedema. Dermatopathology (Basel) 2016; 3:61-7. [PMID: 27504447 PMCID: PMC4965543 DOI: 10.1159/000446699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Hyaluronidases are essential for the breakdown of hyaluronate (HA) in tissues and may be used to prevent the adverse effects of HA fillers. Objectives We explored the effect of hyaluronidase on exogenous and endogenous HA in vitro and in vivo. Materials and Methods HA fillers were incubated with different concentrations of hyaluronidase and visualized by electrophoresis. HA fillers were injected in the skin of hairless mice, and 4 h later hyaluronidase was injected in the papules of exogenous HA. Hyaluronidase was injected in the nodule of pretibial myxedema of a male patient with Graves' disease. Skin sections of mice and of the patient were performed, and a skin ultrasound system was used to monitor the evolution of skin lesions. Results Hyaluronidase showed a degrading effect on HA with increasing concentrations. Hyaluronidase injection significantly decreased the content of exogenous HA within 3 days. Intralesional injection of hyaluronidase resulted in dissolution of the nodule of pretibial myxedema with no recurrence during 3 months. Conclusion These results show that the injection of hyaluronidase is capable of degrading exogenous HA in mouse skin and endogenous HA in human skin in vivo and may be a therapeutic option for skin diseases characterized by abnormal accumulation of HA.
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Affiliation(s)
- Sébastien Menzinger
- Department of Dermatology, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Aysin Kaya
- Swiss Center for Applied Human Toxicology, University of Geneva, Geneva, Switzerland
| | - Jean-Hilaire Saurat
- Swiss Center for Applied Human Toxicology, University of Geneva, Geneva, Switzerland
| | - Gürkan Kaya
- Department of Dermatology, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
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Abstract
The skin of the lower extremity can be a helpful diagnostic tool for systemic disease. Diabetes, renal disease, genetic disorders, and even cancer can have cutaneous manifestations in the legs and feet; moreover, proper diagnosis can facilitate earlier treatment of these diseases and not only clear up the skin symptoms but also bring about resolution of the systemic disease causing them. Although not comprehensive, this article discusses many of these disorders presenting with integumentary manifestations in the lower extremities. Where appropriate, it also enumerates the treatments involved, both systemic and localized.
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Affiliation(s)
- Joseph Vella
- Private Practice, Impression Foot & Ankle, 5656 South Power Road, Suite 124, Gilbert, AZ 85295, USA.
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De Leo S, Palermo NE, Braverman LE. Visual Vignette. Endocr Pract 2016; 22:645. [PMID: 26789345 DOI: 10.4158/ep151138.vv] [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]
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Ramos LO, Mattos PC, Figueredo GLPD, Maia AAA, Romero SAR. Pre-tibial myxedema: treatment with intralesional corticosteroid. An Bras Dermatol 2016; 90:143-6. [PMID: 26312698 PMCID: PMC4540532 DOI: 10.1590/abd1806-4841.20153651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/03/2014] [Indexed: 12/11/2022] Open
Abstract
The pretibial myxedema is a manifestation of Graves' disease characterized by
accumulation of glycosaminoglycans in the reticular dermis. The dermopathy is
self-limiting but in some cases may cause cosmetic and functional damage.
Conventional treatment is use of topical steroids under occlusive dressing, however
the intralesional application has shown good results. We present a case of pretibial
myxedema treated with single injection of intralesional corticosteroid.
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