DefinitionThis section has been translated automatically.
Pretibial (more rarely also in the area of the forearms or shoulders) deposits of glucosamine glycans in the subcutaneous tissue in the case of an underlying thyroid dysfunction (mostly in hyperthyroidism, especially in immunogenic hyperthyroidism of the Graves' type, more rarely in hypothyroidism, e.g. after thyroidectomy).
EtiopathogenesisThis section has been translated automatically.
As in endocrine orbitopathy, there is an increase in the synthesis of hyaluronic acid by fibroblasts in the subcutaneous tissue of the pretibial regions. The cause of this is ultimately unclear. TSH (thyrotropic anterior pituitary hormone) and ESF (exophthalmus stimulating factor) as well as LATS (long acting thyroid stimulating hormone) or the "insulin-like growth factor" are discussed as triggering factors.
You might also be interested in
ManifestationThis section has been translated automatically.
In patients with immunogenic hyperthyroidism( Graves' disease) Also in Hashimoto's thyroiditis, after thyroidectomy or after treatment with thyrostatic drugs.
F>M; preferably in patients after the 35th LJ
1-5% of patients with Graves' disease suffer from pretibial myxedema, and about 25% of patients with exophthalmos.
LocalizationThis section has been translated automatically.
Clinical featuresThis section has been translated automatically.
Circumscribed pretibial, yellowish-brownish or whitish-grey, firm, difficult or impossible to depress, otherwise asymptomatic swellings which usually occur as dermatological partial symptoms of Graves' disease. Often due to retractions of the follicular ostia, orange peel-like surface. However, pretiabial edema may also occur in Hashimoto thyroiditis or without identifiable thyroid disease.
Rarely, acropachy (club-shaped distension of the finger or toe extremities) is seen. Doughy swellings may also occur on the backs of the lower legs, face, and shoulder region. Onycholysis (often ring finger) occurs in about 10% of patients.
If prolonged, also elephantiasis-like swelling of the entire lower legs. Then also epidermal hyperplasia with hyperkeratosis, pruritus and hypertrichosis.
Less frequently, myxoedema may also occur on the face, shoulders and upper extremities (see below Myxoedema circumskriptes).
HistologyThis section has been translated automatically.
The epidermis is slightly acanthotic; orthokeratotic or orthohyperkeratotic keratinization. Massive mucin deposits in the middle and deep dermis; these appear in HE section as optically empty spaces (fixation artefact), between collagenous fibre bundles which are pushed apart (detection of the mucin is best achieved with the alcian blue stain). Fibroblasts only slightly increased. Low diffuse or perivascular lymphocytic infiltrate.
TherapyThis section has been translated automatically.
The treatment is difficult. Relatively good results can be achieved by a consistent compression therapy (especially segmental compression; see lymph drainage below).
In case of moderate or no success glucocorticoid crystal suspensions such as triamcinolone (e.g. Volon A diluted 1:1 with LA such as scandicain), external potent glucocorticoids under occlusion such as clobetasol (e.g. dermoxin cream), if necessary surgical removal of the disturbing tissue. After discontinuation of the therapy, recurrences often occur.
Promising (and recommendable as a therapeutic option), local radiotherapy has been shown in one case study (Elsayad K et al. 2015).
Spontaneous healing can occur (on average after 3.5 years).
The results of plasmapheresis have been reported to vary.
Internal therapyThis section has been translated automatically.
Progression/forecastThis section has been translated automatically.
LiteratureThis section has been translated automatically.
- Anderson CK et al (2003) Triad of exophthalmos, pretibial myxedema, and acropachy in a patient with Graves' disease. J Am Acad Dermatol 48: 970-972
- Bartalena L et al (2014) Extrathyroidal manifestations of Graves' disease: a 2014 update. J Endocrinol Invest 37:691-700
- Cho S et al (2001) Graves' disease presenting as elephantiasic pretibial myxedema and nodules of the hands. Int J Dermatol 40: 276-277
- Elsayad K et al (2015) Radiation therapy as part of the therapeutic regimen for extensive multilocularmyxedema
in a patient with exophthalmos, myxedema and osteoarthropathy syndrome:
A case report. Oncol Lett9:2404-2408.
- Georgala S et al (2002) Pretibial myxedema as the initial manifestation of Graves' disease. J Eur Acad Dermatol Venereol 16: 380-383
- Heise P et al (1992) Myxoedema circumscriptum symmetricum praetibiale. Dermatol Mon 178: 205-206
- Lan C et al (2015) A Randomized Controlled Trial of Intralesional Glucocorticoid for Treating Pretibial Myxedema. J Clin Med Res 7:862-872.
- Mir M et al (2011) Pretibial mucinosis in a patient without Graves disease. Cutis 88:300-302
- Nair PA et al (2014) Pretibial Myxedema Associated with Euthyroid Hashimoto's Thyroiditis: A Case Report. J Clin Diagn Res PubMed PMID: 25121051
- Schleicher SM et al (1994) Treatment of pretibial mucinosis with gradient pneumatic compression. Arch Dermatol 130: 842-844
- Schwartz KM et al (2002) Dermopathy of Graves' disease (pretibial myxedema): long-term outcome. J Clin Endocrinol Metab 87: 438-446
- Susser WS et al (2002) Elephantiasic pretibial myxedema: a novel treatment for an uncommon disorder. J Am Acad Dermatol 46: 723-726
Incoming links (11)Emo syndrome; Myxoderma tuberosum praetibiale; Myxodermia circumscripta symmetrica praetibiale; Myxoedema circumscript; Myxoedema pretibiales; Myxoedema tuberosum; Myxoedema tuberosum praetibiale; Myxoedem circumscriptes pretibiales; Myxoederma circumscriptum thyreotoxicum; Pretibial myxedema; ... Show all
Outgoing links (7)Compression therapy; Glucocorticosteroids; Glucocorticosteroids systemic; Hypertrichoses; Immunogenic hyperthyroidism; Lymph drainage; Plasmapheresis;
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.