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Pretibial Myxedema Presenting as Severe Elephantiasis
Jae-Hoon Lee1, Sang-Myung Park2, Bark-Lynn Lew2
1Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
Annals of Dermatology
|April 29, 2021
Summary
This case report details severe elephantiasis caused by pretibial myxedema (PTM) in a patient with high thyroid stimulating hormone (TSH) receptor antibodies. It highlights a rare, severe manifestation of autoimmune thyroid disease.
Area of Science:
- Endocrinology and Immunology
Background:
- Pretibial myxedema (PTM) is a rare skin manifestation associated with autoimmune thyroiditis, most commonly Graves' disease.
- It typically presents as localized skin thickening on the anterior lower legs.
Observation:
- A 49-year-old male presented with severe elephantiasis affecting the pretibial areas, feet, ankles, and toes.
- The patient had a history of radioactive iodine treatment for thyrotoxicosis 20 years prior.
- Despite normal thyroid function, TSH receptor antibodies were significantly elevated (>40 IU/L).
Findings:
- Biopsy confirmed PTM, with TSH receptor antibodies detected in the deep dermal connective tissue.
- This case represents a rare and severe presentation of elephantiasic PTM.
Implications:
- This case underscores the potential for severe cutaneous manifestations in autoimmune thyroid disease, even with normalized thyroid function.
- It suggests a possible direct role of TSH receptor antibodies in the pathogenesis of severe PTM and elephantiasis.
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