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An Bras Dermatol 2019 Nov 25. Epub 2019 Nov 25.

Graduate and Post-Graduate Program in Dermatology, Faculdade Suprema, Juiz de Fora, MG, Brazil; Work Performed in the Dermatological Research Center of HU-CAS Ebserh, Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil.

Localized pretibial myxedema is a dermopathy whose treatment is a challenge in dermatology, occurring in 0.5-4% of patients with Graves' disease. This autoimmune thyroid condition stimulates the production of hyaluronic acid (HA) and glycosaminoglycans (GAG) that are deposited particularly in the pretibial region. Read More

Eur Thyroid J 2020 Jan 14;9(1):55-56. Epub 2019 Nov 14.

Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Best Pract Res Clin Endocrinol Metab 2020 Jan 4;34(1):101388. Epub 2020 Feb 4.

Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. Electronic address:

Graves' disease (GD) is characterized by thyrotoxicosis, caused by the presence of circulating thyroid stimulating antibodies (TSAb), that are determinant also in the pathogenesis of its extrathyroidal manifestations [Graves' ophthalmopathy (GO), pretibial myxedema]. T helper (Th)1 immune response prevails in the immune-pathogenesis of GD and GO, during the active phase, when Th1 chemokines, and their (C-X-C)R3 receptor, play a key role. In GD, the existing treatments are not ideal for hyperthyroidism (long-term remission with anti-thyroid-drugs only in 50% of patients; while radioiodine and surgery cause hypothyroidism). Read More

Eur Thyroid J 2019 Oct 11;8(5):278-282. Epub 2019 Jun 11.

Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy.

Background: The pathogenesis of the extrathyroidal manifestations of Graves' disease (GD) is not fully clarified. According to the most common hypothesis, they would reflect an autoimmune reaction against antigens constitutively expressed by the thyroid and by the extrathyroidal affected tissues. According to another hypothesis, the so-called Kriss' hypothesis, soluble autoantigens released from the thyroid would reach the affected tissues, where they would become the target of the immune system. Read More

Cutis 2019 Sep;104(3):E1-E3

University of Texas MD Anderson Cancer Center, Houston, USA.

Lancet 2019 Oct;394(10206):1364

Department of Internal Medicine, OLVG East, Amsterdam, Netherlands.

Br J Dermatol 2019 11 24;181(5):e117. Epub 2019 Jul 24.

Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.

Probl Endokrinol (Mosk) 2019 06 30;65(2):134-138. Epub 2019 Jun 30.

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology.

Pretibial myxedema (PTM) or thyroid dermopathy is a rare extrathyroidal manifestation of Graves' disease. The condition is accompanied by mucinous skin changes, mainly in the anterior tibial surface. Severe forms may lead to lymphatic congestion and disability. Read More

Indian Dermatol Online J 2019 Mar-Apr;10(2):162-164

Department of Skin and STD, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India.

Localized myxedema is most commonly described in patients with hyperthyroidism, especially Graves' disease. Although pretibial myxedema generally appears as indurated plaques on the shins, it has also been rarely reported in other areas such as the face, shoulders, arms, and abdomen. We report a rare case of preradial myxedema in a hyperthyroid patient who was taking thyroxine post thyroidectomy for goiter. Read More

Dermatol Online J 2019 Feb 15;25(2). Epub 2019 Feb 15.

Department of Dermatology, Mount Sinai Hospital, New York City, New York.

Pretibial myxedema or thyroid dermopathy constitutes dermal deposition of mucin, primarily hyaluronic acid and chondroitin sulfate. It is a manifestation of autoimmune thyroiditis, seen more in Graves disease than in Hashimoto thyroiditis. The time delay from treatment of hyperthyroidism to appearance of localized myxedema varies from one month to 16 years (mean 5. Read More

Thyroid 2019 05 8;29(5):692-699. Epub 2019 Apr 8.

1 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota.

Severe pretibial myxedema (PTM) can be difficult to manage, highlighting the need to investigate newer therapies. Rituximab (RTX) and intravenous immunoglobulin (IVIg) have been tried in Graves' orbitopathy. Since PTM and orbitopathy share a similar underlying pathophysiology, this study aimed to explore these therapies for progressive PTM. Read More

Aten Primaria 2019 12 4;51(10):654-655. Epub 2019 Mar 4.

Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, España.

Dermatol Ther 2019 05 4;32(3):e12854. Epub 2019 Mar 4.

Department of Dermatology, Yildirim Beyazit University, Medical School, Ankara, Turkey.

Intravenous immunoglobulins (IVIG) are therapeutic products, comprising polyclonal IgGs, which are obtained from human plasma pool of healthy blood donors. Despite the lack of Food and Drug Administration (FDA) approval, the experience of using IVIG in various dermatological diseases increases day by day and exciting results are reported. However, experience with the use of IVIG in dermatological indications are mostly case reports whereas randomized, controlled, double-blind, multicentric studies have not been performed. Read More

World J Clin Cases 2018 Nov;6(14):854-861

Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.

Pretibial myxedema (PTM), an uncommon manifestation of Graves' disease (GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. Read More

Med Clin (Barc) 2019 05 15;152(9):375. Epub 2018 Oct 15.

Servicio de Dermatología, Hospital Regional Universitario de Málaga, Málaga, España.

JAAD Case Rep 2018 Oct 3;4(9):874-876. Epub 2018 Oct 3.

Department of Dermatology, Mayo Clinic, Jacksonville, Florida.

Aten Primaria 2019 03 20;51(3):189-190. Epub 2018 Sep 20.

Medicina Familiar y Comunitaria, Servicio de Urgencias, ICS-Atenció Primària Costa de Ponent, Hospital de Viladecans, Viladecans, Barcelona, España.

Pediatr Dermatol 2018 Nov 6;35(6):e371-e374. Epub 2018 Sep 6.

George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.

The extrathyroid manifestations of Graves disease (GD) include thyroid orbitopathy, dermopathy, and acropachy. Thyroid dermopathy (TD), also known as pretibial myxedema, classically presents as nonpitting edema or plaquelike lesions on the pretibial region, while thyroid acropachy (TA) is seen in cases of severe TD, characterized by soft tissue swelling and clubbing of fingers and toes, as well as a periosteal reaction of the bones of the hands and feet. Both TD and TA are rare manifestations of thyroid disease and uncommonly reported in pediatric patients. Read More

Hormones (Athens) 2018 Mar 17;17(1):133-135. Epub 2018 Apr 17.

Division of Endocrinology, Police Medical Center of Thessaloniki, Monastiriou 326, 54121, Thessaloniki, Greece.

Pretibial myxedema (PM) is a rare extrathyroidal manifestation of Graves' disease (GD), usually during the hyperthyroid state, coexisting with orbitopathy. We describe a rare case of a biopsy-proven PM in a euthyroid patient, without history of GD or Hashimoto's thyroiditis. Assessment of commonly reported thyroid autoantibodies, such as thyroid peroxidase and thyroglobulin autoantibodies, thyroid stimulating immunoglobulins and thyroid binding inhibitory immunoglobulins, was negative. Read More

Ophthalmic Plast Reconstr Surg 2018 Jul/Aug;34(4S Suppl 1):S20-S27

Department of Medicine and Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.

Purpose: Thyroid autoimmunity affects approximately 5% of the population, and its investigation relies heavily on the use of autoantibodies. Thyroid stimulating hormone receptor (TSHR) autoantibodies (TRAb) play a central role in the evaluation of Graves disease (GD), Graves ophthalmopathy (GO) and pretibial myxedema (PTM). However, there is still controversy regarding overall TRAb assay diagnostic accuracy and their prognostic utility. Read More

Dermatopathology (Basel) 2018 Jan-Mar;5(1):16-20. Epub 2018 Feb 6.

Section of Dermatology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.

Cutaneous mucinoses are a group of conditions characterized by increased amounts of acid mucin in the dermis. They can be generalized or localized and occur isolated or in the setting of systemic diseases. Obesity-associated lymphedematous mucinosis is a distinct variant of mucinosis occurring in obese patients without any thyroid dysfunction. Read More

Clin Med Insights Endocrinol Diabetes 2018 21;11:1179551418759076. Epub 2018 Mar 21.

Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Background: Graves disease (GD) has increased in prevalence over the past decade in Africa. Despite this, the condition is not well described, especially in sub-Saharan Africa.

Objective: We have described the clinical characteristics and associated factors of GD in a cohort of patients attending a resource-limited setting tertiary hospital. Read More

Indian J Dermatol Venereol Leprol 2018 Nov-Dec;84(6):763

Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Transl Pediatr 2017 Oct;6(4):300-312

The Ohio State University College of Medicine, Columbus, OH, USA.

The skin serves as a window for clinicians to understand, diagnose, and monitor endocrine disease. Dermatologic manifestations of endocrinopathies contribute significantly to an individual's health and quality of life. In this review, we outline various disorders of the hypothalamic-pituitary axis, thyroid gland, pancreas, adrenal gland, and androgen axis as well as hereditary endocrine syndromes. Read More

Postgrad Med J 2018 04 18;94(1110):236. Epub 2017 Nov 18.

Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Ther Clin Risk Manag 2017 8;13:1189-1194. Epub 2017 Sep 8.

Department of Endocrinology and Nephrology, Chongqing Emergency Medical Hospital (The Fourth People's Hospital of Chongqing).

Objective: Local immune regulation therapy has been one of the therapeutic methods used for the treatment of autoimmune thyroid disease in patients with pretibial myxedema (PTM). However, the poor response rate and high recurrence rate are still major problems. Whether a premixed corticosteroid, compound betamethasone, could enhance remission rate and decrease recurrence rate in patients with PTM was investigated in the present study. Read More

Chin Med J (Engl) 2017 Aug;130(15):1887-1888

Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences, Beijing 100730, China.

Wounds 2017 Mar;29(3):77-79

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL.

The authors report a case of pretibial myxedema (PTM) masquerading as a venous leg ulcer to alert wound care clinicians to this diagnostic possibility. Pretibial myxedema is a localized form of mucin cutaneous deposition characterized by indurated plaques most commonly on anterior legs. It is more likely to present in patients with Graves' disease, but it can be found in euthyroid patients as well. Read More

Pan Afr Med J 2016 14;25. Epub 2016 Sep 14.

Médecine Interne, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Sénégal.

Basedow-Graves disease is an autoimmune affection characterized by the association of thyrotoxicosis with variable frequency events such as goiter, ophthalmopathy and pretibial myxedema. Its diagnosis is often easy, while its management remains difficult. A simple medical treatment exposes patient to recurrence risk. Read More

J Dermatol 2018 Jan 2;45(1):110-111. Epub 2017 Feb 2.

Department of Dermatology, Kansai Medical University, Osaka, Japan.

J Eur Acad Dermatol Venereol 2017 May 28;31(5):e265-e267. Epub 2016 Oct 28.

Laboratory of Electron Microscopy, Embrapa Clima Temperado (Brazilian Agricultural Research Corporation), Pelotas, Brazil.

J Thyroid Res 2016 25;2016:2652174. Epub 2016 Aug 25.

Department of Dermatology, China National Nuclear Corporation (CNNC) 416 Hospital, No. 4 Er Huan Lu Bei Si Duan, Chengdu, Sichuan 610051, China.

Background. Pretibial myxedema (PTM) is a rare dermopathy. The morphologic features and mechanism of its evolving process are not reported in large case series. Read More

Dermatopathology (Basel) 2016 Jul-Sep;3(3):61-7. Epub 2016 Jul 6.

Department of Dermatology, University Hospital of Geneva, University of Geneva, Geneva, Switzerland.

Background: Hyaluronidases are essential for the breakdown of hyaluronate (HA) in tissues and may be used to prevent the adverse effects of HA fillers.

Objectives: We explored the effect of hyaluronidase on exogenous and endogenous HA in vitro and in vivo.

Materials And Methods: HA fillers were incubated with different concentrations of hyaluronidase and visualized by electrophoresis. Read More

Int J Dermatol 2016 Jul 12;55(7):e413-5. Epub 2016 Feb 12.

Department of Dermatology, University of Trieste, Trieste, Italy.

Res Cardiovasc Med 2016 Feb 9;5(1):e30549. Epub 2015 Dec 9.

Second Department of Cardiology, Attikon University Hospital, University of Athens, Athens, Greece.

Introduction: Pulmonary hypertension is common among patients with hyperthyroidism, and Graves' disease constitutes the most common cause of thyrotoxicosis.

Case Presentation: We report the case of a female patient admitted to the cardiology department with shortness of breath and pretibial myxedema. The diagnostic work-up revealed combined pre- and post-capillary pulmonary hypertension due to Graves' disease superimposed on left ventricular diastolic dysfunction. Read More

Acta Derm Venereol 2016 06;96(5):714-5

Department of Dermatology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, China.

World J Gastroenterol 2015 Dec;21(48):13582-6

Yulia Evsyutina, Alexander Trukhmanov, Vladimir Ivashkin, Olga Storonova, Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University, 119991 Moscow, Russia.

Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema (dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. Read More

J Am Acad Dermatol 2015 Dec;73(6):e195-6

Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.

J Clin Med Res 2015 Nov 25;7(11):862-72. Epub 2015 Sep 25.

Department of Dermatology, China National Nuclear Corporation 416 Hospital, No.4, Er Huan Lu Bei Si Duan, Chengdu City, Sichuan Province, China.

Background: Pretibial 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. Read More

An Bras Dermatol 2015 May-Jun;90(3 Suppl 1):143-6

Universidade Federal do Amazonas, Manaus, AM, BR.

The pretibial myxedema is a manifestation of Graves' disease characterized by accumulation of glycosaminoglycans in the reticular dermis. The dermopathy is self-limiting but in some cases may cause cosmetic and functional damage. Conventional treatment is use of topical steroids under occlusive dressing, however the intralesional application has shown good results. Read More

QJM 2015 Dec 31;108(12):985. Epub 2015 Jul 31.

Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605 006, India. email:

Oncol Lett 2015 May 26;9(5):2404-2408. Epub 2015 Feb 26.

Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany.

Exophthalmos, myxedema and osteoarthropathy (EMO) comprise the triad known as EMO syndrome, which is rarely observed in patients with autoimmune thyroid disease. The present study reports the case of a patient with EMO, including the response of this rare combination to radiotherapy. A 48-year-old patient with EMO syndrome presented to the Department of Radiation Oncology, University Hospital of Muenster, eight years prior to writing with therapy-resistant pretibial myxedema and hypertrophic osteoarthropathy of the metacarpal bones. Read More

Int J Dermatol 2015 Aug 27;54(8):e280-6. Epub 2015 May 27.

Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Introduction: Pretibial myxedema (PTM) is a rare manifestation of Graves' disease. There is paucity of data regarding long-term follow-up and response to treatment in PTM.

Materials And Methods: Retrospective study wherein 30 patients of PTM presenting during 2001-2011 attending dermatology and endocrinology outpatient departments were analyzed. Read More

J Dermatol 2014 Oct 9;41(10):941-2. Epub 2014 Sep 9.

Department of Dermatology, Tokyo Medical University, Tokyo, Japan.

Cutis 2014 Aug;94(2):60, 73-4

University of Iowa Hospitals and Clinics, Department of Dermatology, 200 Hawkins Dr, Iowa City, IA 52242, USA.

J Clin Diagn Res 2014 Jun 20;8(6):YD01-2. Epub 2014 Jun 20.

Resident, Department of Dermatology and Venereology, Pramukhswami Medical College , Karamsad, Anand, Gujarat, India .

Pretibial myxedema (PM) is an infiltrative dermopathy which is seen in grave's disease. It is also associated with hypothyroidism, but is infrequently seen in Hashimoto's thyroiditis. Lesions are seen commonly over pretibial region as non-pitting oedema or with a plaque morphology. Read More

J Endocrinol Invest 2014 Aug 10;37(8):691-700. Epub 2014 Jun 10.

Department of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA.

Introduction: Graves' orbitopathy (GO), thyroid dermopathy (also called pretibial myxedema) and acropachy are the extrathyroidal manifestations of Graves' disease. They occur in 25, 1.5, and 0. Read More

Clin Nucl Med 2014 Aug;39(8):758-9

From the Departments of *Emergency Medicine, and †Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Pretibial myxedema is a rare manifestation of Graves disease and is generally associated with ophthalmopathy. Steroids, immunoglobulin, or rituximab can have some therapeutic effect but not curative. Here we reported a 45-year-old man with history of hyperthyroidism for 20 years who developed severe bilateral pretibial myxedema. Read More