Elephantiasic form of severe pseudotumorous pretibial myxedema: A case report

Pretibial myxedema is an infrequent complication of Graves' disease and is described in patients with goiter and Graves' opthalmolpathy. Severe forms were reported to occur in patients who developed hypothyroidism after treat ment for Graves' disease. The pathogenesis of this disorder is unclear. A s erum factor other than thyroid-binding immunoglobulin seems to be responsib le for the stimulation of the fibroblast with enhanced mucin synthesis. The treatment of this thyroid dermopathy is medical. However, surgical interve ntion may be necessary. Recurrences of this dermopathy are common. We repor t a case of severe pretibial nodular myxedema associated with radioactive t reated Graves' followed by un treated hypothyroidism. This patient required plastic surgery for extensive foot deformity. The unusual presentation and the extensive skin involvement presented a diagnostic challenge for many s pecialists who evaluated this patient.