Pretibial myxedema (PTM) is an uncommon, late manifestation of Graves'
disease. It is nearly always preceded by significant ophthalmopathy a
nd classically presents as nonpitting (brawny) edema of the lower extr
emities. We report a case of PTM that is unusual because of its morpho
logic evolution, that it occurred prior to the diagnosis of Graves' di
sease, and in the absence of ophthalmopathy.