Elephantiasic Pretibial Myxedema
Internal medicine (Tokyo. 1992)
A 33-year-old Chinese man presented with bilateral, asymmetric, indurated non-pitting waxy verrucous plaques with an orange peel-like appearance on both lower legs that had been present for three years (Pictures 1, 2). Four years earlier, he had received radioactive iodine treatment for Graves' disease. Despite topical corticosteroids with occlusive or compressive therapy, the skin lesions showed no signs of remission under euthyroid status (thyroidstimulating hormone: 2.216 uIU/mL (0.35-4.9);
... uIU/mL (0.35-4.9); free thyroxine: 14.06 pmol/L (9.03-19.09), total triiodothyronine: 1.617 nmol/L (1.29-2.65)), but his anti-TSH receptor antibody titer was elevated, at 40% (normal <15%). Pretibial myxedema typically arises on the anterior tibia in a bilateral, asymmetrical distribution. It may occur before, during, or after treatment for Graves' disease. The patho-genesis is unclear and the severity is unassociated with levels of T4 or T3 (1). Treating the elephantiasic variant is difficult and has no relationship with the control of thyrotoxicosis. Intralesional or topical corticosteroids with or without occlusion may be valuable, whereas surgical excision is not recommended (2). The authors state that they have no Conflict of Interest (COI ). References 1. Senel E, Gulec AT. Euthyroid pretibial myxedema and EMO syndrome. Acta Dermatovenerol Alp Panonica Adriat 18: 21-23, 2009. 2. Susser WS, Heermans AG, Chapman MS, Baughman RD. Elephantiasic pretibial myxedema: a novel treatment for an uncommon disorder.