Endocrine Abstracts

Background: Untreated hypothyroidism may be associated with cutaneous signs including coarse, dry skin and hair loss. Myxoedema (also known as thyroid dermopathy) is usually associated with Graves’ thyrotoxicosis but has been reported in patients with hypothyroidism. We describe an unusual skin disorder in a patient with autoimmune hypothyroidism, initially misdiagnosed as myxoedema.

Case: A 41-year-old female with an extensive medical history including autoimmune hypothyroidism, acute myeloid leukaemia, carpal tunnel syndrome and previous patellectomy was referred to clinic due to persistent tiredness and weight gain despite increasing doses of levothyroxine therapy. She was maintained on levothyroxine 125 μg od and her thyroid function tests were consistently within the normal range. Despite this she reported gain in weight of 20 kg over 7 months. She also reported the appearance of multiple, rapidly enlarging, painful, fatty deposits on her legs, which she had been advised were due to hypothyroidism. Clinical examination revealed multiple, large (>10 cm) lipomatous lesions which did not resemble the non-pitting oedema and skin discolouration usually associated with myxoedema. Further investigation resulted in a diagnosis of adiposis dolorosa, known as Dercum’s disease. This rare, progressive syndrome of unknown aetiology is characterised by multiple, painful lipomas, obesity, fatigue and mental disturbance. It may also be associated with thyroid dysfunction (usually hypothyroidism), musculoskeletal pain, irritable bowel syndrome and chondromalacia patellae.

Conclusions: It is unusual to see cutaneous signs in patients with hypothyroidism, particularly when receiving adequate levothyroxine replacement. Thyroid dermopathy is usually associated with Graves’ disease, thus patients with hypothyroidism who report skin changes as a prominent feature may warrant further examination. Adiposis dolorosa is a rare, progressive skin disorder which usually develops in middle age and is five times more common in women. It may be associated with thyroid dysfunction and may present as persistent fatigue and weight gain despite biochemical euthyroidism.