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 2017 Feb 2. 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 Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy,

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

Int J Low Extrem Wounds 2014 Jun 7;13(2):152-154. Epub 2014 May 7.

University of Toronto, Toronto, Ontario, Canada.

Pretibial myxedema (PM) is a rare autoimmune manifestation of Graves' disease, which commonly presents as diffuse, nonpitting edema of shins and less often as plaques, nodules, or elephantiasis lesions mimicking lymphedema. We present a 57-year-old woman with 12-month history of PM, which occurred a year after treatment of Graves' disease and improved with topical corticosteroids, support stockings, and intralesional steroid injections until recurrence with local erythema and woody edema. A literature review was undertaken of the evidence-based treatment modalities for symptomatic PM: although commonly asymptomatic and self-limited, severe cases of PM may be treated with topical corticosteroid, compressive therapy, and intralesional corticosteroid injections. Read More

BMJ Case Rep 2014 Apr 2;2014. Epub 2014 Apr 2.

Department of Endocrinology and Metabolism, Texas A&M, Temple, Texas, USA.

Am J Case Rep 2014 14;15:111-4. Epub 2014 Mar 14.

Department of Internal Medicine, Iwakiri Hospital, Sendai, Japan.

Patient: Female, 56 FINAL DIAGNOSIS: Thyroiditis - silent Symptoms: Palpitations • pretibial pitting edema • short of breath • sweating

Medication: - Clinical Procedure: - Specialty: Endocrinology and Metabolic.

Objective: Unknown etiology.

Background: Hyper- or hypothyroidism sometimes causes pretibial myxedema characterized by non-pitting infiltration of a proteinaceous ground substance. Read More

Dtsch Med Wochenschr 2014 Mar 25;139(10):483-5. Epub 2014 Feb 25.

Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein Campus Lübeck.

History And Admission Findings: A 51-year-old man presented with progressive tiredness, proximal muscle weakness, hair loss and weight gain for months. The patient showed mild pretibial myxedema and dry skin. Laboratory findings revealed strongly elevated cardiac enzymes as well as marked hypothyroidism. Read More

Dermatoendocrinol 2014 Jan-Dec;6(1):e981078. Epub 2015 Jan 26.

Department of Dermatology; Employees' State Insurance Post Graduate Institute of Medical Science and Research ; New Delhi, India.

Thyroid dermopathy is an uncommon manifestation of autoimmune thyroid disease. About 0.5%-4. Read More

Dermatol Online J 2013 Apr 15;19(4). Epub 2013 Apr 15.

Nirvana Skin Clinic, Vadodara, Gujarat, India.

Localized or pretibial myxedema is one of the signs of Graves disease (along with goiter, exophthalmus, thyroid acropathy, and high circulating levels of long-acting thyroid-stimulating hormone) and usually tends to occur at a later stage of the disease or even after the patient becomes euthyroid post treatment. Very rarely has it been reported in euthyroid patients. We report a euthyroid man presenting with localized myxedema on the extensor surface of his forearm with clinical and histopathological features consistent with pretibial myxedema. Read More

Arq Bras Oftalmol 2013 Jan-Feb;76(1):50-1

Department of Ophthalmology, Universidade Federal de São Paulo - São Paulo (SP), Brazil.

The present study reports two cases of symptomatic essential trichomegaly. Trichomegaly may develop in various diseases, including anorexia nervosa, hypothyroidism, pregnancy, pretibial myxedema, systemic lupus erythematosus, vernal keratoconjunctivitis, and uveitis. The exact incidence trichomegaly is unknown, and the condition remains sporadically reported. Read More

Ann Dermatol Venereol 2013 May 21;140(5):382-5. Epub 2013 Mar 21.

Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France.

Background: Localized myxoedema is a rare dermopathy in patients with Graves' disease. The pretibial area is the most commonly affected region but herein we present a case of myxoedema of the big toe.

Patients And Methods: A 44-year-old male with Graves' disease ongoing for seven years presented bilateral ophthalmopathy and myxoedema of the big toes. Read More

Indian J Med Res 2013 Mar;137(3):568

Division of Infectious Diseases & Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan, China.

Am J Med Sci 2013 Jul;346(1):73-5

Department of Internal Medicine, Baptist Health System, Birmingham, AL 35213, USA.

Objective: To report a rare case of Graves' disease without ophthalmopathy presenting with pretibial myxedema (PM) as an initial presentation.

Methods: We present the clinical history, physical findings, laboratory studies and biopsy data of a 62-year-old man with a history of uncontrolled type 2 diabetes (DM2) presenting with arm and leg skin lesions in the absence of other physical findings. Histopathology confirmed PM. Read More

Thyroid 2013 May;23(5):626-32

Endocrine Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione Cà Granda IRCCS, Milan, Italy.

Pretibial myxedema (PTM) is a rare extrathyroidal manifestation of Graves' disease that requires treatment when the clinical picture is markedly evident. In addition to topical treatment with steroid ointments, there have been previous reports of subcutaneous injections of steroids. This procedure may cause nodular degeneration of the skin due to fat atrophy when standard needles are used. Read More

Orv Hetil 2012 Oct;153(43):1719-22

Maros Megyei Klinikai Kórház, Bőrgyógyászati Klinika, Marosvásárhely.

Pretibial myxoedema is a rare symptom of Graves' disease. Histological studies detected mucopolysaccharide and glycosaminoglycan accumulation, and the role of anti-TSH receptor antibodies has been suggested. In this paper the authors present the case of a 34-year-old male patient with pretibial myxoedema treated successfully with pentoxifylline. Read More

Intern Med 2012 1;51(19):2837. Epub 2012 Oct 1.

Department of Dermatology, Kaohsiung Veterans General Hospital, Taiwan.

J Med Case Rep 2012 Aug 30;6:258. Epub 2012 Aug 30.

Internal Medicine Clinic, South Estonian Hospital, Meegomäe, Võru vald, 65526, Estonia.

Introduction: Graves' hyperthyroidism has a number of well-recognized but relatively rare extrathyroid manifestations such as thyroid acropachy, pretibial myxedema, and congestive heart failure.

Case Presentation: A 38-year-old Caucasian woman presented to the out-patient clinic with symptoms of hyperthyroidism lasting for approximately five months. Remarkably, she had developed pitting edema of her left leg four months before. Read More

Clin Endocrinol (Oxf) 2012 Sep;77(3):465-70

Section of Diabetes and Endocrinology, Department of Medicine, Caerphilly Miners' Hospital, Caerphilly, UK.

Context: Sequential conversion of Hashimoto's thyroiditis (HT) to Graves' disease (GD) is uncommon. Distinct immune paradigms, paucity of functioning tissue in long-standing HT, and infrequent conversion of blocking (TBAb) to stimulating (TSAb) thyrotrophin receptor antibody (TRAb) may account for this. Molecular and crystal structure analysis helps delineate TSH receptor (TSHR)/TRAb interactions in detail. Read More

Cutis 2011 Dec;88(6):300-2

Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA.

Although an uncommon location, cutaneous mucinoses may present in the pretibial area in distinct clinical circumstances. The terms pretibial myxedema and pretibial mucinosis often are used interchangeably, but pretibial myxedema should be regarded as a type of pretibial mucinosis. We present a case of cutaneous mucinosis localized to the pretibial area of a patient without Graves disease. Read More

Australas J Dermatol 2012 Feb 10;53(1):e1-4. Epub 2010 Sep 10.

Department of Dermatology, Fremantle Hospital, Western Australia, Australia.

A 44-year-old woman was diagnosed with Graves' disease in 1995 and over the following 12 months developed thyroid dermopathy (pretibial myxoedema). Despite being trialled on multiple recognized therapies over the course of 11 years, the patient's dermopathy progressively worsened. She developed ocular proptosis, elephantiasic thyroid dermopathy and acropachy in both hands. Read More

Clin Exp Dermatol 2012 Apr 18;37(3):307-8. Epub 2011 Oct 18.

Br J Dermatol 2012 Feb 5;166(2):457-9. Epub 2011 Dec 5.

Ochsner J 2011 ;11(2):132-8

Localized extratibial myxedema is a rare presentation of thyroid disease that manifests with varied symptoms. Previous surgical or radioiodine treatment of hyperthyroidism is linked to the development of localized myxedema, as is prior trauma or surgery. We present the first known case of localized foot myxedema on a background of Graves disease following a traumatic and surgical precipitant and compare and discuss similar cases found in a literature review. Read More

Int J Low Extrem Wounds 2011 Jun 26;10(2):91-2. Epub 2011 May 26.

University of the West Indies, Champ Fleurs, Trinidad and Tobago.

Although pretibial myxedema (PTM) occurs in 4.3% of patients with Graves's disease, the most severe variant, elephantiasis nostras verrucosa, is found in less than 1% of cases. The most frequent location of infiltration is the lower extremities, especially the pretibial areas and on the dorsum of the foot. Read More

Eur J Endocrinol 2011 Apr 25;164(4):605-11. Epub 2011 Jan 25.

Institute of Biomedical Engineering, National Taiwan University, No.1, Sec.1, Jen-Ai Road, Taipei 100, Taiwan ROC.

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. Read More

Case Rep Dermatol Med 2011 30;2011:386081. Epub 2011 Nov 30.

Medical College of Georgia, Augusta, GA 30004, USA.

The cutaneous manifestations of thyroid disease can be present in the hair, nails, and local or diffuse locations throughout the skin. Traditionally, thyroid-associated mucin deposition is present in a pretibial location on bilateral lower legs. We present a case of a growing plaque on the lower back of a 10-year-old girl, whose appearance coincided with a recent diagnosis of Hashimoto's thyroiditis. Read More

Thyroid 2011 Jan 16;21(1):83-5. Epub 2010 Dec 16.

Endocrinology Department, Guangzhou General Hospital of Guangzhou Military Command Region, Guangzhou, China.

Background: Pretibial myxedema (PM) is an uncommon and characteristic manifestation of Graves' disease (GD), with local autoimmune reaction in cutaneous tissue. The treatment of PM is a clinical challenge. We herein report a patient with PM who achieved complete remission by multipoint subcutaneous injection of long-acting glucocorticid. Read More

J Craniofac Surg 2010 Jul;21(4):1199-201

Unit of Cranio Maxillo Facial Surgery, Centre for Craniofacial Deformities and Orbital Surgery, and Department of Ophthalmology, St Anna Hospital and University, 44100 Ferrara, Italy.

Endocrine orbitopathy (EO) is a chronic, multisystem autoimmune disorder caused by lymphocyte infiltration, edema, and proliferation of endo-orbital connective tissue. These conditions involve the extraocular muscles, intraconal and extraconal fat, and, to a lesser extent, the lacrimal gland.Endocrine orbitopathy may be associated with toxic diffuse goiter and/or pretibial myxedema (Graves disease) and may appear without alterations in thyroid function (euthyroidism). Read More

Intern Med 2010 1;49(7):665-9. Epub 2010 Apr 1.

Center of Endocrinology and Metabolism, Medical Plaza Daido, Naha.

Localized pretibial myxedema (PTM) is a sign of Graves' disease. A 53-year-old man with Graves' disease was admitted with the development of PTM following radioisotope (131)I treatment for Graves' hyperthyroidism. TSH receptor antibody (TRAb) titer was also increased after (131)I treatment. Read More

J Hosp Med 2010 Jan;5(1):59

Department of Dermatology, University of Chicago Medical Center, Chicago, Illinois, USA.

Am J Dermatopathol 2010 Apr;32(2):196-7