Endocrine Abstracts

Introduction: Graves’ dermopathy (also known as pretibial myxedema, thyroid dermopathy, Jadassohn-Dösseker disease or myxedema tuberosum) is a rare extrathyroidal manifestation of Graves’ disease, which is almost always associated with Graves’ ophthalmopathy. Although pretibial myxedema is the most frequent localization of Graves’ dermopathy, the involvement of toes with or without the involvement of pretibial area may occur.

Objectives: Presentation of a case with severe Graves’ dermopathy involving toes and associating pretibial myxedema and acropachy, in a male patient with longstanding Basedow Graves’ disease.

Case presentation: We present a case of a young adult male (37 years) with severe Graves’ dermopathy associating pretibial myxedema and acropachy. The patient was diagnosed 9 years ago with hyperthyroidism due to Basedow Graves Disease, and performed total thyroidectomy 3 years later, being treated with levothyroxine since then. He also received methylprednisolone for ophthalmopathy, with a cumulative dose of 3 grams. At that time he presented a small erythematous lesion in pretibial area, and infiltrative lesions involving the toes, with symmetric and bilateral distribution. After being lost to follow-up for 4 years, he is admitted to our clinic accusing insomnia, and presenting extensive bilateral painless infiltrative lesions of the toes, with significant progression in the past years, despite local administration of glucocorticoids. The erythematous lesion in pretibial area did not show any signs of progression. He also presents asymmetric bilateral exophthalmia that was stable during the last 5 years, and acropachy. Blood samples revealed subclinical hypothyroidism suggesting suboptimal levothyroxine substitution with still very high levels of TRAb. The ophthalmologic exam suggested stationary ophthalmopathy. Due to the high recurrence of surgical treated Graves dermopathy, and the lack of response to local glucocorticoid treatment, systemic glucocorticoids and radiation therapy may be considered to be a part of therapeutic regimen and may improve the quality of life in this patient.

Conclusions: Although Graves dermopathy is almost always a benign condition, the extensiveness of the lessions may have an important influence in patient’s quality of life, especially when glucocorthycoid therapy is uneffective, since surgical treatment is not an viable option due to high recurrence rate.