ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P1187 | DOI: 10.1530/endoabs.63.P1187

Pretibial myxedema in Graves' disease: about two cases

Yousra Aouinati1,2, Siham El Aziz2,3, Amal Mjaber1,2 & Asmaa Chadli1,2

1Department of Endocrinology, Diabetology and Metabolic Diseases. UHC Ibn Rochd, Casablanca, Morocco; 2Laboratory of Neuroscience and Mental Health Faculty of Medicine and Pharmacy, Hassan II-Casablanca University, Casablanca, Morocco; 3Department of Endocrinology, Diabetology and Metabolic Diseases. UHC Ibn Rochd, Casablanca, Morocco.

Introduction: Grave’ disease is associated with extra thyroid auto-thyroid manifestations such as basal ophthalmopathy and/or. We report the case of two patients presenting with extrathyroid manifestations of the basic illness hospitalized at the department of diabetic endocrinology and metabolic diseases of Ibn Rochd University Hospital of Casablanca.

Case 1: This is a patient aged 53 years, chronic smoking at 20 years, for low weight disease since 5 years, under Dimazole 05 mg/day. Clinical examination found moderate ophthalmopathy with grade 2 exophthalmos and a clinical activity score of 4 with a pretentious myxedema of digital clubbing. Paraclinically, anti-reactive TSH Ab above 40 U/l, orbital MRI showed Hypertrophy occulomotor muscles, while the ultrasound of the parties was demonstrated distal third infiltration of the two legs, and the biopsie confirmed yhe diagnosis. Patient receved oral corticosteroid in ordre to prepare him for Iratherapy. During follow-up, inflammatory signs of ophthalmopathy disappeared, whereas pretitibial myxedema stably persisted at 2 years after irathérapie.

Case 2: This is the 37-year-old patient, followed by grave’s disease under 25 mg of progressive Dimazol for 12 years, with the appearance of pratibial myxedema since 2 years. Clinical examination found moderate ophthalmopathy with a clinical activity score of 4 with pre-tibial myxedema. On the paraclinical TSH level, is free, the Ab anti-powers of TSH are greater than 40 U/l, orbital CT is a hypertrophy of right muscles, nerves, normal optics, absence of exophthalmos. The patient took a bolus of corticosteroids to manage her orbitopathy, with titration of doses of Dimazol, waiting for euthyroidism to receive radical therapy with Iratherapy.

Conclusion: Dermopathies are a rare manifestation in the Grave’s disease, of preferential localization pretibial. Myxedema is almost always associated with ophthalmopathy. Treatment is mainly based on corticosteroid therapy.

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