Nodular Thyroid Dermopathy: Not a Hallmark of Graves Disease

Published:November 14, 2018DOI:
      A 40-year-old man presented to the outpatient department with complaints of multiple, nontender, raised nodular lesions on his shins bilaterally for the past year (Figure 1). The lesions had an insidious onset and were progressively increasing in size. He was evaluated at an outside clinic. Biopsy was performed multiple times, and possibility of spindle cell lipoma and myxoid liposarcoma was kept. The patient was referred to our institute for further management. However, on eliciting a detailed history, he had easy fatigability and cold intolerance. General physical examination revealed dry and coarse skin. The thyroid gland was not palpable. Deep tendon reflexes were delayed, suggestive of hypothyroidism. Laboratory investigations revealed suppressed FT4 (0.7 ng/mL), and elevated thyroid-stimulating hormone levels (104 mU/L), thus confirming the diagnosis of primary hypothyroidism. Thyroid peroxidase antibodies were raised (860 U/mL). Review of histopathology slides revealed marked dermal mucin, consistent with pretibial myxedema. The patient was started on levothyroxine therapy and steroid occlusive dressings for primary hypothyroidism and pretibial myxedema, respectively.
      Figure 1Raised nodular lesions on patient's shins at presentation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Doshi DN
        • Blyumin ML
        • Kimball AB
        Cutaneous manifestations of thyroid disease.
        Clin Dermatol. 2008; 26: 283-287
        • Salvi M
        • De Chiara F
        • Gardini E
        • et al.
        Echocardiographic diagnosis of pretibial myxedema in patients with autoimmune thyroid disease.
        Eur J Endocrinol. 1994; 2: 113-119
        • Fatourechi V
        • Pajouhi M
        • Fransway AF
        Dermopathy of Graves’ disease (pretibial myxedema). Review of 150 cases.
        Medicine (Baltimore). 1994; 73: 1-7
        • Fatourechi V.
        Pretibial myxedema: pathophysiology and treatment options.
        Am J Clin Dermatol. 2005; 6: 295-309