Thyroid dermopathy-a diagnostic clue of hidden hyperthyroidism

Thyroid dermopathy is an uncommon manifestation of autoimmune thyroid disease. About 0.5%-4.3% of patients with history of thyrotoxicosis and 15% of patients with severe Graves' ophthalmopathy have this cutaneous manifestation. However thyroid dermopathy is almost always associated with ophthalmopathy (96%) and sign and symptoms of hyperth-yroidism. The diagnosis of thyroid dermopathy is based on clinical sign and symptoms, serological thyroid hormone abnormalities supported by skin pathology. Isolated dermopathy is an uncommon manifestation of hyperthyroidism. A 35-year-old male presented with 7 months history of asymptomatic, multiple skin colored nodulo-tumorous growth over anterior aspect of both leg and one erythematous plaque with mild central atrophy on left leg. On examination most of the nodulo-tumorous growth (1 cm × 1 cm to 4 cm × 4 cm) and plaque (3 cm × 4 cm) showed 'peau d' orange' appearance and were firm in consistency, indurated, non-tender with no rise of local temperature. Complete systemic and ophthalmological examination revealed no abnormalities. Abnormal thyroid function test and cutaneous deposition of mucin on histopathology suggested the diagnosis.The case is reported for its uncommon manifestation. Clinical sign should be documented and analysis of skin histopathology should be carried out in patients with suspected thyroid dermopathy.