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

Background. Pretibial myxedema (PTM) is a rare dermopathy. The morphologic features and mechanism of its evolving process are not reported in large case series. Methods. 216 cases with PTM were retrospectively reviewed to analyze demographics, history, lesional morphology and its evolving process, histopathology and immunohistochemistry, serum TRAb levels, treatment, and outcome. Results. First appearing lesions evolved into 6 variants that were correlated with serum TRAb levels. Subvariants were caused by different kinds and frequencies of local trauma. The evolving process could be classified into 4 stages that were correlated with serum TRAb levels and perivascular infiltration of CD8+ and CD4+ lymphocytes. Serum TRAb levels at remission and in nonrecurred cases became lower than those before therapy and in recurred cases, respectively, but increased when PTM relapsed. TRAb level in nodule variant went down invariably with the extension of course and its autoimmune activity had a trend to stop but in other 5 variants TRAb levels fluctuated. Their autoimmune activities had no trends to stop and clinically worsen through intermittent repeats of active and stable stages. Conclusions. In the chronic course of PTM, nodule variant is self-limited and other 5 variants are not self-limited. PTM needed early treatment to avoid severe variants.

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“…The tumor and elephantiasis resulted in both disfiguration and disability. So PTM requires early treatment to avoid severe variants [19, 43]. …”

Section: Discussionmentioning

confidence: 99%

Morphological Diversity of Pretibial Myxedema and Its Mechanism of Evolving Process and Outcome: A Retrospective Study of 216 Cases

Lan

Wang

Zeng

et al. 2016

Journal of Thyroid Research

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“…On the other hand, severe variants progressed from non-severe variants [ 17 ], and severe variants could even make patients disabled. So it is necessary for the PTM patients to receive early treatment [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Intralesional Glucocorticoid for Treating Pretibial Myxedema

Lan

Chen

et al. 2015

J Clin Med Res

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BackgroundPretibial myxedema (PTM) is an uncommon dermopathy associated with autoimmune thyroid diseases. Now it is thought to be autoimmune and its treatment with glucocorticoid is helpful. However, it has not been evaluated.MethodsA prospective randomized controlled trial was performed in 110 patients with PTM to evaluate the efficacy and safety of triamcinolone acetonide with intralesional injection once every 3 days and once every 7 days. Randomization was performed with drawing lots and it was also stratified according to variants of PTM lesions. In the follow-up, recurrent rates were observed. The SPSS Statistics 17.0 Software was used in the statistical analysis.ResultsThe complete response rates were 78.2%, 83.6%, and 87.3% in regimen 1 and 50.9%, 89.1%, and 90.9% in regimen 2 at 3 weeks, 7 weeks and the end of therapy, respectively. Regimen 1 had an earlier efficacy than regimen 2, but at 7 weeks and end of therapy, there were no differences between two regimens. The majority of non-severe variants got complete response but severe variants did not. The adverse reaction rates in regimen 1 were higher and earlier than those in regimen 2. Adverse reaction occurring time in regimen 1 was shorter than that in regimen 2. Recurrent rates were 31.25% and 32% in regimens 1 and 2 at 3.5-year follow-up.ConclusionsFor its autoimmune, hyperplasia and disabled features, early treatment of PTM with glucocorticoid is necessary to get complete response. Dosage and frequency of intralesional steroid injection and lesional variants influence the efficacy of PTM. Once every 7 days is a better regimen.

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“…So, once PTM occurs, it has to be treated early [24] in order to prevent it from developing into severe types and then influencing family labor supply.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Pretibial Myxedema in Chinese Outpatients With Thyroid Diseases

et al. 2015

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

Abstract: Localized pretibial myxedema (PTM) is a sign of

Cited by 25 publications

References 14 publications

Morphological Diversity of Pretibial Myxedema and Its Mechanism of Evolving Process and Outcome: A Retrospective Study of 216 Cases

Morphological Diversity of Pretibial Myxedema and Its Mechanism of Evolving Process and Outcome: A Retrospective Study of 216 Cases

A Randomized Controlled Trial of Intralesional Glucocorticoid for Treating Pretibial Myxedema

Prevalence and Clinical Characteristics of Pretibial Myxedema in Chinese Outpatients With Thyroid Diseases

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