INTRODUCTION Pretibial myxedema is a characteristic - PowerPoint PPT Presentation

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INTRODUCTION Pretibial myxedema is a characteristic extrathyroidal manifestation of Graves disease as well as exophthalmic orbitopathy. This symptom is believed to be a rare complication with nodular and localized myxedema in the lower

INTRODUCTION Pretibial myxedema is a characteristic extrathyroidal manifestation of Graves’ disease as well as exophthalmic orbitopathy. This symptom is believed to be a rare complication with nodular and localized myxedema in the lower extremities. Ho wever, we have noticed in our clinic that Graves’ disease patients were frequently complained with thick legs, mainly for a cosmetic reason. The formation of their legs was not the characteristic nodular localization but rather diffuse infiltration in all over the lower extremities. The examination of the affected legs by finger oppression showed non-pitting edema exhibiting elastic softness suggesting deposits of glycosaminoglycans(GAG).
PURPOSE OF THE STUDY To examine whether thickend legs are common in Graves ’ disease patients.
MATERIALS AND METHODS One-hundred and seventy-two (172) women (16-39 years in age) N Subjects Graves ’ Disease 54 Hashimoto ’ s Thyroiditis 68 Normal Subjects 50 The circumferences of the leg (ankle and calf) were determined using a tape measure.
RESULTS －Ⅰ Ankle/Calf Subjects N Ankle (cm) Calf (cm) Ratio Graves ’ 21.8 ± 2.2 * 0.62 ± 0.05 * 54 35.4 ± 3.6 disease Hashimoto 68 20.7 ± 1.9 34.7 ± 2.6 0.60 ± 0.04 Normals 50 20.1 ± 1.5 34.1 ± 2.9 0.59 ± 0.03 (mean ± SD) * Graves ’ disease patients vs normal subjects. (P < 0.01)
RESULTS －Ⅱ The ultrasonography showed diffuse deposits of lower echogenetic materials in the subcutaneous area, indicating GAG accumulation. The affected legs had decreased sensitivity to the temperature by hot patch test, but normal sensitivity to the pin-pricking test. Among Graves ’ disease patients, the ankles in patients with ophthalmopathy were not significantly different from those without ophthalmopathy (22.3. ± 2.4 cm vs 21.9 ± 2.0 cm).
CONCLUSION The diffuse but not localized infiltration of GAG, predominantly in the ankle region, seems to be a common extrathyroidal complication of Graves ’ disease. A Graves ’ disease patient whose ankle/calf ratio is greater than 0.66 (2/3) has a possibility of diffuse myxedema due to GAG accumulation.
CALF Graves' Hashimoto Normal Disease Disease Subjects
ANKLE P < 0.01 Graves' Hashimoto Normal Disease Disease Subjects
ANKLE/CALF RATIO P < 0.01
Reprinted from J Clin Endocrinol Metab. 87:438-446,2002 (Schwartz KM et al)

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