[Immunopathogenetic, endocrinologic and therapeutic problems of EMO syndrome. Observations based on a case report]

The EMO-syndrome (thyroid acropachy) consists of the triad of exophthalmus, circumscribed pretibial myxedema and hypertrophic osteoarthropathy. The clinical picture is seen in thyroid disorders, as a rule occurring in hyperthyroidism, rarely in hypothyroid or euthyroid states. Our 47 year old female patient showed a hyperthyroidism in the beginning. The thyrostatic treatment resulted in a euthyroid stage. Serum antibodies against microsomal thyroid gland antigen with high titers were detected. The immunosuppressive treatment resulted in a titer reduction, but not in an improvement of the disease. The pathogenetical importance of the thyroid stimulating immunoglobulins and the role of aggressive and destructive antibodies against thyroid gland for the development of EMO-syndrome are discussed.