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Long-term graft survival and renal function have improved in renal transplant recipients since 1996.

Graves' disease is an autoimmune disorder of the thyroid gland that can be accompanied by extra-thyroidal manifestations. These include ophthalmopathy, present in 30% of patients, and, less commonly, dermopathy (pretibial myxoedema) in 1-4% of patients. 1 Much less frequent (<1%) is acropachy (osteoarthropathy) with finger clubbing. This triad constitutes the exophthalmos, pretibial myxoedema and osteoarthropathy (EMO) syndrome. 2 We present a patient with myxoedema in the ureter, which has not been described previously.The patient was a 36-year-old woman whose brother had type 1 diabetes and whose mother had type 2 diabetes. She was diagnosed with Graves' disease at the age of 24 years, at week 28 of a twin pregnancy with foetal tachycardia. Her blood test showed:TSH <0Á1 mU/l [reference range (RR) 0Á3-5]; FT4 80Á5 pM (RR 10-21); FT3 19Á2 pM (RR 3-5); and TSH receptor Ab 76 IU/l (RR <2). She was treated with high-dose propylthiouracil, and a and b blockers for hypertension. Following an induced birth, the twins weighed 2Á0 and 1Á7 kg, and both had neonatal hyperthyroidism, requiring treatment for 5 and 8 months, respectively, until thyroid function was normalized. They are currently euthyroid.The patient's condition was difficult to control, requiring high doses of antithyroid drugs (60 mg of carbimazole), but her TSH remained at 0Á1 and her TSH receptor Ab was 50-70 U/ml (nor-

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