A Case of Thyroid Dermopathy

Thyroid dermopathy is a relatively uncommon extrathyroidal manifestation of autoimmune thyroid disease in which there is localized thickening of the skin due to accumulation of glycosaminoglycans. Thyroid dermopathy is classified as a cutaneous mucinosis and is thought to occur in less than 5% of all patients with Graves' disease, most commonly in the setting of severe thyroid eye disease. We present a case of a forty-year-old woman with long-standing Graves' disease and thyroid eye disease who developed progressive thyroid dermopathy over years. Despite partial response to intralesional glucocorticoid and hyaluronidase, definitive symptom control was not obtained until immunomodulatory therapy was started for other concomitant autoimmune conditions. Here we present a case of significant thyroid dermopathy that responded well to systemic immunomodulatory therapy that was prescribed for concomitant autoimmune conditions. This case underscores the diagnostic challenges and limited treatment options for thyroid dermopathy and discusses the potential role for systemic therapy in more advanced disease.