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General hyperpigmentation induced by Grave's disease: A case report.

Xiaoxiao Song¹, Yimin Shen^1,2, Ying Zhou³

¹Department of Endocrinology, The Second Affiliated Hospital of Zhejiang University School of Medicine.

|December 15, 2018

Summary

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This case study presents a rare instance of diffuse hyperpigmentation linked to Grave's disease. Treatment for hyperthyroidism successfully reduced the skin pigmentation, suggesting a hormonal link.

Area of Science:

Endocrinology
Dermatology
Internal Medicine

Background:

Hyperpigmentation is a common dermatological condition.
Diffuse hyperpigmentation associated with Grave's disease is exceptionally rare.
This report details a unique case linking these two conditions.

Observation:

A 42-year-old woman presented with generalized skin hyperpigmentation, particularly on the face and extremities.
Laboratory results revealed elevated free thyroxine (FT4), elevated free triiodothyronine (FT3), suppressed thyroid-stimulating hormone (TSH), and positive anti-TSH receptor antibody (TRAb).
Physical examination showed grade I goiter and increased thyroid uptake on scan; histopathology confirmed melanin pigmentation.

Findings:

The patient was diagnosed with hyperpigmentation secondary to Grave's disease.

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Treatment with methimazole and a beta-blocker led to the amelioration of hyperthyroid symptoms and the abatement of hyperpigmentation.

Proposed mechanisms include elevated adrenocorticotropic hormone (ACTH) and anti-TSH receptor stimulating antibodies.

Implications:

This case highlights a potential, albeit rare, cutaneous manifestation of Grave's disease.
It suggests a possible role for hormonal imbalances, specifically ACTH and TRAb, in thyroid-related hyperpigmentation.
Further research is warranted to elucidate the precise mechanisms of skin pigmentation in hyperthyroidism.