Dermopathy of Graves Disease (Pretibial Myxedema)

Fatourechi, Vahab; Pajouhi, Mohammad; Fransway, Anthony F.

doi:10.1097/00005792-199401000-00001

Cited by 183 publications

(129 citation statements)

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“…Pretibial myxedema (PTM) is an uncommon manifestation of autoimmune thyroid disease almost always associated with Graves' ophthalmopathy (GO) and found in an estimated 10 -12% of these patients (1). Most affected patients have severe ophthalmopathy and high serum titers of thyrotropin receptor (TSH-R) antibodies.…”

Section: Introductionmentioning

confidence: 99%

Evidence for thyrotropin receptor immunoreactivity in pretibial connective tissue from patients with thyroid-associated dermopathy

Daumerie

Ludgate²,

Costagliola³

et al. 2002

European Journal of Endocrinology

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Pretibial myxedema (PTM), mainly characterized by the accumulation of glycosaminoglycans in the dermis and subcutaneous tissue, is an extrathyroidal manifestation of autoimmune Graves' disease (GD), almost always associated with Graves' ophthalmopathy (GO). The thyrotropin receptor (TSH-R) has been proposed as the common target antigen in GD, GO and PTM, with evidence for receptor transcripts and/or protein in these locations. The aim of this study has been to investigate whether receptor protein is present in the pretibial tissues. Skin biopsies were obtained from two patients with PTM and two normal subjects without thyroid disease. A portion of each sample was fixed to produce semi-thin sections for Toluidine Blue or Periodic Acid Schiff (PAS) staining. The remainder was snap frozen to generate cryostat sections for immunohistochemical analysis using three monoclonal antibodies against TSH-R. In the skin from the two patients suffering from PTM, the dermis was infiltrated by inflammatory cells (lymphocytes, B cells, macrophages, mast cells) and adipocytes. The collagen fibers were dissociated by edema and by the accumulation of a PAS-positive material. Immunodetection of TSH-R produced positive staining on cells localized in the dermis, beneath the epidermis or close to the hypodermis. These cells were elongated and resembled fibroblasts. No immunoreactivity was observed in the dermis from control patients without thyroid disease. In conclusion, we have evidence for TSH-R immunoreactivity in the pretibium of patients with GD, GO and PTM. Further studies are needed to unambiguously identify the positive cells and determine whether the reactivity is due to the receptor itself or to a cross-reacting protein.

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Section: Introductionmentioning

confidence: 99%

Evidence for thyrotropin receptor immunoreactivity in pretibial connective tissue from patients with thyroid-associated dermopathy

Daumerie

Ludgate²,

Costagliola³

et al. 2002

European Journal of Endocrinology

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“…In the present report, we describe a patient, in whom PTM developed after radioisotope 131 I treatment for Graves' hyperthyroidism. TRAb also increased after 131 (2,3,(10)(11)(12). Kriss et al (10) and Fatourechi et al (2,3) have reported moderate benefits of topical corticosteroid therapy.…”

Section: Localized Myxedema Is An Infrequent Manifestation Of Graves'mentioning

confidence: 90%

“…Kriss et al (10) and Fatourechi et al (2,3) have reported moderate benefits of topical corticosteroid therapy. A long-term experience with thyroid dermopathy has been reported by only one group (2,3,13 A 53-year-old Japanese man visited our department with rapidly developing localized pretibial myxedema (PTM) and was admitted to our hospital (Fig. 1A, Fig.…”

Section: Localized Myxedema Is An Infrequent Manifestation Of Graves'mentioning

confidence: 99%

Treatment of Pretibial Myxedema (PTM) with Topical Steroid Ointment Application with Sealing Cover (Steroid Occlusive Dressing Technique: Steroid ODT) in Graves' Patients

2010

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“…None of them were diagnosed with peripheral arterial occlusive disease or arteritis. Some patients with Graves' dermopathy received systemic corticosteroid therapy after DITI had been performed (5,18). Eight patients with PM, 21 patients with mild diffuse non-pitting edema, 21 patients with normal appearance of lower legs, and 11 normal volunteers also received soft tissue sonography for investigating DITI change.…”

Section: Patientsmentioning

confidence: 99%

“…Nodules and plaques may form in chronic lesions (2). Dermopathy was classified into four forms according to its appearance: non-pitting edema accompanied by typical skin color change (diffuse form), plaque form, nodular form, and elephantiasis (5). Treatment and follow-up often require months to years (6,7).…”

Section: Introductionmentioning

confidence: 99%

Observing pretibial myxedema in patients with Graves' disease using digital infrared thermal imaging and high-resolution ultrasonography: for better records, early detection, and further investigation

Shih

Lin²,

Li³

et al. 2011

European Journal of Endocrinology

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Objective: Pretibial myxedema (PM) is a manifestation of Graves' disease (GD). Currently, its diagnosis depends on physicians' observation and biopsy. No satisfactory, objective, and non-invasive tool is available to record and investigate lesions. Digital infrared thermal imaging (DITI) detects surface temperature, and sonography reflects composition changes in soft tissue. This study was aimed to observe changes in DITI and sonography in PM, and to evaluate their clinical usefulness. Methods: Nineteen GD patients with PM, 22 GD patients with mild diffuse non-pitting edema over lower legs, 46 GD patients with normal appearance of lower legs, and 14 normal volunteers were recruited for observation with DITI; 8, 21, 21, and 11 of them respectively also received soft tissue sonography for investigating the pathogenesis of DITI change. Results: Lower leg temperatures of normal volunteers decreased gradually from proximal to distal parts. In all 19 patients with PM, DITI showed abnormally low focal temperatures over the lesions. In GD patients with mild diffuse non-pitting edema and GD patients with normal appearance of lower legs, DITI showed abnormally low focal temperature in 90.9 and 65.2% of the patients respectively. Areas of clinically visible PM and low focal temperature detected by DITI were sonographically characterized with increased skin thickness, hypoechoic substance deposition in the cutaneous tissue, and blurred boundary lines between dermis and subcutaneous tissue. TSH receptor antibody level correlated positively and significantly with skin thickness change and adjusted temperature difference between the center of temperature defect and the surrounding skin (PZ0.046 and 0.033 respectively). Conclusions: By using DITI and sonography, we detected characteristic changes in PM. These techniques are helpful in recording and may be useful tools to detect early changes of PM.

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Dermopathy of Graves Disease (Pretibial Myxedema)

Cited by 183 publications

References 0 publications

Evidence for thyrotropin receptor immunoreactivity in pretibial connective tissue from patients with thyroid-associated dermopathy

Evidence for thyrotropin receptor immunoreactivity in pretibial connective tissue from patients with thyroid-associated dermopathy

Treatment of Pretibial Myxedema (PTM) with Topical Steroid Ointment Application with Sealing Cover (Steroid Occlusive Dressing Technique: Steroid ODT) in Graves' Patients

Observing pretibial myxedema in patients with Graves' disease using digital infrared thermal imaging and high-resolution ultrasonography: for better records, early detection, and further investigation

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