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Lack of effect of long-term octreotide therapy in severe thyroid-associated dermopathy
Pnina Rotman-Pikielny1, Françoise Brucker-Davis, Maria L Turner
1Clinical Endocrinology Branch, National Institute of Diabetes, Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland 20892, USA.
Abstract:
Severe thyroid associated dermopathy (TAD), a rare complication of Graves' disease, currently lacks effective treatment. Mediators of growth and inflammation, including insulin-like growth factor-1 (IGF-1) and somatostatin (SST) have been implicated in its pathogenesis. Octreotide, a potent SST analogue, has been used in TAD with anecdotal success. Therefore, we evaluated the efficacy of long-term octreotide therapy in moderate to severe TAD. Three obese women with TAD were studied. Baseline treatment included levothyroxine, methimazole, fluocinonide ointment under occlusive dressing, and physiotherapy for lymphedema. After establishing baseline clinical status, octreotide was started (300 microg subcutaneously daily) for 10 to 28 months. Studies obtained at baseline and every 3 months included: leg circumference, skin examination, clinical photography, self-reported clinical status, body mass index (BMI), serum thyrotropin (TSH) and free thyroxine, titers of antithyroidal and anti-TSH receptor antibodies. Minimal changes in the edema, erythema, skin texture and size of nodules were observed. The minor changes seen followed significant decreases in the patients' BMI, and hence, cannot be specifically attributed to octreotide administration. No clinically significant benefit from long-term octreotide therapy was demonstrated in three patients with moderate to severe TAD. Weight loss and measures such as compression bandaging and topical corticosteroid application still remain the most cost effective treatment modalities for TAD.
Insights
Long-term octreotide therapy showed no significant benefit for moderate to severe thyroid-associated dermopathy (TAD). Current treatments like weight loss and topical corticosteroids remain the most effective options for TAD management.
Area of Science:
- Endocrinology
- Dermatology
Background:
- Thyroid-associated dermopathy (TAD), a rare Graves' disease complication, lacks effective treatments.
- Insulin-like growth factor-1 (IGF-1) and somatostatin (SST) are implicated in TAD pathogenesis.
- Octreotide, an SST analogue, has shown anecdotal success in TAD.
Observation:
- Three obese women with moderate to severe TAD received long-term octreotide therapy (300 mcg daily) for 10-28 months.
- Baseline treatments included levothyroxine, methimazole, topical fluocinonide, and physiotherapy.
- Clinical status, leg circumference, skin condition, BMI, and thyroid function were monitored.
Findings:
- Minimal changes in edema, erythema, skin texture, and nodule size were observed.
- Observed minor improvements correlated with significant decreases in patients' BMI, not specifically octreotide.
- No clinically significant benefit was demonstrated from long-term octreotide therapy in the studied TAD patients.
Implications:
- Long-term octreotide therapy is not a clinically effective treatment for moderate to severe TAD.
- Weight loss, compression bandaging, and topical corticosteroids remain the most cost-effective TAD management strategies.
- Further research into novel therapeutic targets for TAD is warranted.