Pretibial myxoedema

139 Pretibial myxoedema



Instruction


Look at this patient’s legs.



Salient features



History




• As in patients with thyrotoxicosis (p. 137)



Examination




• Red thickened swellings above the lateral malleoli (peau d’orange appearance), which progresses to thickened non-pitting oedema of the feet.


• Examine the following:


• The hands for acropachy (Fig. 136.1), palmar erythema and warm, sweaty palms

• The neck for goitre and thyroidectomy scar

• The eyes for exophthalmos (Fig. 137.1)

• The pulse for tachycardia and atrial fibrillation.

• Tell the examiner that you would like to know whether or not the patient has had any treatment, in particular radioactive iodine.


Remember:



• Almost all cases of thyroid dermopathy are associated with relatively severe ophthalmopathy.


• Usually ophthalmopathy appears first and dermopathy much later.



Diagnosis


This patient has pretibial myxoedema (lesion) with ophthalmopathy and signs of thyrotoxicosis (functional status), which is caused by Graves’ disease.



Questions




What investigations would you do?


Serum thyroxine (T4), triiodothryonine (T3) and thyroid-stimulating hormone (TSH).



How are these lesions treated?




• Intralesional steroids or fluorinated corticosteroids applied under polythene occlusion


• Plasmapheresis


• Cytotoxic therapy


• Octreotide.

Related posts:

  1. Permanent cardiac pacemaker/implantable cardioverter-defibrillator
  2. Cauda equina syndrome
  3. Dermatomyositis
  4. Dystrophia myotonica

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Pretibial myxoedema

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