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Graves' disease presenting as elephantiasic pretibial myxedema and nodules of the hands

Identifieur interne : 009F15 ( Main/Exploration ); précédent : 009F14; suivant : 009F16

Graves' disease presenting as elephantiasic pretibial myxedema and nodules of the hands

Auteurs : Soyun Cho [Corée du Sud] ; Jee-Ho Choi [Corée du Sud] ; Kyung-Jeh Sung [Corée du Sud] ; Kee-Chan Moon [Corée du Sud] ; Jai-Kyoung Koh [Corée du Sud]

Source :

RBID : ISTEX:1C8DF41186D35F4A81936D55476A4FCC579F99B8

Abstract

A 67‐year‐old man presented with a 2‐year history of asymptomatic, firm, multiple nodules and plaques and cerebriform hypertrophy of both lower legs and feet, and well‐defined, skin‐colored, firm nodules and tumors on both hands. He had been diagnosed as having Graves' disease 3 years previously, and had been treated with 10 mg of methimazole and 100 μg of thyroxin (T4) daily for 2 years. Physical examination revealed nonpitting edema, flesh‐colored to erythematous, firm, confluent, polypoid nodules and fissured plaques extending from the shins to the dorsa of both feet (Fig. 1), and round to oval, firm, skin‐colored, walnut‐to‐egg‐sized tumors on all 10 fingers and the ulnar side of the dorsum of the right hand (Fig. 2). The thyroid gland was diffusely enlarged; however, there was no exophthalmos, and extraocular movements were normal. There was no weight loss, loss of appetite, tremor, heat intolerance, diarrhea, or fatigue. On laboratory evaluation, thyroid‐stimulating hormone (TSH) had a markedly low titer of < 0.05 μU/mL (normal: 0.4–5.0), and the TSH receptor antibody was extremely high at 73.8% (normal: < 15%). Serum free triiodothyronine (T3), T4, antimicrosome, and antithyroglobulin antibodies were normal or negative. Skin biopsy samples from the shin and hand disclosed extensive mucin deposition throughout the dermis. Confluent, firm nodules and plaques on both shins and the dorsa of both feet Firm, nonpitting, well‐circumscribed, flesh‐colored masses with orange‐peel appearance of overlying skin and growth of coarse hair on the dorsum of the right hand

Url:
DOI: 10.1046/j.1365-4362.2001.01108.x


Affiliations:


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<div type="abstract" xml:lang="en">A 67‐year‐old man presented with a 2‐year history of asymptomatic, firm, multiple nodules and plaques and cerebriform hypertrophy of both lower legs and feet, and well‐defined, skin‐colored, firm nodules and tumors on both hands. He had been diagnosed as having Graves' disease 3 years previously, and had been treated with 10 mg of methimazole and 100 μg of thyroxin (T4) daily for 2 years. Physical examination revealed nonpitting edema, flesh‐colored to erythematous, firm, confluent, polypoid nodules and fissured plaques extending from the shins to the dorsa of both feet (Fig. 1), and round to oval, firm, skin‐colored, walnut‐to‐egg‐sized tumors on all 10 fingers and the ulnar side of the dorsum of the right hand (Fig. 2). The thyroid gland was diffusely enlarged; however, there was no exophthalmos, and extraocular movements were normal. There was no weight loss, loss of appetite, tremor, heat intolerance, diarrhea, or fatigue. On laboratory evaluation, thyroid‐stimulating hormone (TSH) had a markedly low titer of < 0.05 μU/mL (normal: 0.4–5.0), and the TSH receptor antibody was extremely high at 73.8% (normal: < 15%). Serum free triiodothyronine (T3), T4, antimicrosome, and antithyroglobulin antibodies were normal or negative. Skin biopsy samples from the shin and hand disclosed extensive mucin deposition throughout the dermis. Confluent, firm nodules and plaques on both shins and the dorsa of both feet Firm, nonpitting, well‐circumscribed, flesh‐colored masses with orange‐peel appearance of overlying skin and growth of coarse hair on the dorsum of the right hand</div>
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