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hypothyroidism marked by dry skin and swellings around lips and nose as well as mental deterioration (同)myxoedema

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/01/25 02:37:43」(JST)

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Pretibial myxedema (myxoedema (UK), also known as Graves Dermopathy, thyroid dermopathy,^[1] Jadassohn-Dösseker disease or Myxoedema tuberosum) is an infiltrative dermopathy, resulting as a rare complication of Graves' disease,^[2] with an incidence rate of about 1-5% in patients.

Presentation

It usually presents itself as a waxy, discolored induration of the skin—classically described as having a so-called peau d'orange (orange peel) appearance—on the anterior aspect of the lower legs, spreading to the dorsum of the feet, or as a non-localised, non-pitting edema of the skin in the same areas.^[3] In advanced cases, this may extend to the upper trunk (torso), upper extremities, face, neck, back, chest and ears.

The lesions are known to resolve very slowly. Application of petroleum jelly on the affected area could relieve the burning sensation and the itching. It occasionally occurs in non-thyrotoxic Graves' disease, Hashimoto's thyroiditis, and stasis dermatitis. The serum contains circulating factors which stimulate fibroblasts to increase synthesis of glycosaminoglycans.

Risk Factors

There are suggestions in the medical literature that treatment with Radioactive Iodine for Graves' hyperthyroidism may be a trigger for pretibial myxedema^[4] which would be consistent with radioiodine ablation causing or aggravating Ophthalmopathy, a condition which commonly occurs with pretibial myxedema and is believed to have common underlying features.^[5]

Other known triggers for ophthalmopathy include thyroid hormone imbalance, and tobacco smoking, but there has been little research attempting to confirm these are also risk factors for pretibial myxedema.

Diagnosis

A biopsy of the affected skin reveals mucin in the mid- to lower- dermis. There is no increase in fibroblasts. Over time, secondary hyperkeratosis may occur, which may become verruciform. Many of these patients may also have co-existing stasis dermatitis. Elastic stains will reveal a reduction in elastic tissue.

References

^ Schwartz, K. M.; Vahab Fatourechi, Debra D. F. Ahmed and Gregory R. Pond (1 February 2002). "Dermopathy of Graves' Disease (Pretibial Myxedema): Long-Term Outcome". Journal of Clinical Endocrinology & Metabolism 87 (2): 438–446. doi:10.1210/jc.87.2.438. Cite uses deprecated parameters (help)
^ Prajapati VH, Mydlarski PR (March 2008). "Dermacase. Pretibial myxedema". Can Fam Physician 54 (3): 357, 369. PMC 2278349. PMID 18337527.
^ Rongioletti F, Rebora A (2007). "Mucinoses". In Bolognia JL. Dermatology. St. Louis: Mosby. pp. 616–7. ISBN 1-4160-2999-0.
^ Harvey, R. D.; Metcalfe, R. A.; Morteo, C.; Furmaniak, W.; Weetman, A. P.; Bevan, J. S. (1 June 1995). "Acute pre-tibial myxoedema following radioiodine therapy for thyrotoxic Graves' disease". Clinical Endocrinology 42 (6): 657–660. doi:10.1111/j.1365-2265.1995.tb02695.x.
^ PEACEY, S.R.; FLEMMING, L.; MESSENGER, A.; WEETMAN, A.P. (1 February 1996). "Is Graves' Dermopathy a Generalized Disorder?". Thyroid 6 (1): 41–45. doi:10.1089/thy.1996.6.41.

UpToDate Contents

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1. 自己免疫性甲状腺疾患における前脛骨部粘液水腫 pretibial myxedema in autoimmune thyroid disease
2. 成人における浮腫の臨床症状および診断 clinical manifestations and diagnosis of edema in adults
3. 甲状腺機能亢進症の診断 diagnosis of hyperthyroidism
4. うっ滞性皮膚炎 stasis dermatitis
5. 甲状腺機能低下症の臨床症状 clinical manifestations of hypothyroidism

English Journal

Pretibial Myxedema Without Ophthalmopathy: An Initial Presentation of Graves' Disease.

Subramanyam S, Lohiya V, Stahl EJ.SourceDepartment of Internal Medicine (SS, VL), Baptist Health System, Birmingham, Alabama; and Department of Diabetes (EJS), Metabolism & Endocrinology Simon Williamson Clinic, Birmingham, Alabama.
The American journal of the medical sciences.Am J Med Sci.2013 Mar 19. [Epub ahead of print]
OBJECTIVE:: To report a rare case of Graves' disease without ophthalmopathy presenting with pretibial myxedema (PM) as an initial presentation. METHODS:: We present the clinical history, physical findings, laboratory studies and biopsy data of a 62-year-old man with a history of uncontrolled type 2
PMID 23514670

TREATMENT OF PRETIBIAL MYXEDEMA WITH DEXAMETAZONE INJECTED SUBCUTANEOUSLY BY MESOTHERAPY NEEDLES.

Vannucchi G, Campi I, Covelli D, Forzenigo L, Beck-Peccoz P, Salvi M.SourceFondazione IRCCS Cà Granda, Endocrine Unit, Dept. of Clinical Sciences and Community Health, Milan, Italy; guiava@libero.it.
Thyroid : official journal of the American Thyroid Association.Thyroid.2013 Feb 11. [Epub ahead of print]
Pretibial myxedema (PTM) is a rare extrathyroidal manifestation of Graves' disease that requires treatment when the clinical picture is markedly evident. In addition to topical treatment with steroid ointments, there had been previous reports of subcutaneous injections of steroids. This procedure ma
PMID 23397966

[Treatment of pretibial myxoedema with pentoxifylline].

Türke B, Balázs C.SourceMaros Megyei Klinikai Kórház, Bőrgyógyászati Klinika, Marosvásárhely.
Orvosi hetilap.Orv Hetil.2012 Oct 28;153(43):1719-22. doi: 10.1556/OH.2012.29472.
Pretibial myxoedema is a rare symptom of Graves' disease. Histological studies detected mucopolysaccharide and glycosaminoglycan accumulation, and the role of anti-TSH receptor antibodies has been suggested. In this paper the authors present the case of a 34-year-old male patient with pretibial myxo
PMID 23089171

Japanese Journal

PUVA療法が奏効した甲状腺機能亢進症に伴う脛骨前粘液水腫の1例 (特集代謝異常症・沈着症・黄色腫)

皮膚科の臨床 57(3), 257-260, 2015-03
NAID 40020382567

症例 Basedow病術後の甲状腺ホルモン内服自己中断後に発症したpretibial myxedemaの1例

内科 113(4), 788-792, 2014-04
NAID 40020028683

Elephantiasic Pretibial Myxedema

Internal Medicine 51(19), 2837-2837, 2012
NAID 130002062041

Related Pictures

Pretibial Myxedema | Graves disease, Thyroid disease, Thyroid Pretibial Myxedema - Pictures, Treatment, Symptoms, Causes | HubPages [專業] Pretibial myxedema in Graves' disease View Image Pretibial myxedema causes, symptoms, diagnosis, treatment & prognosis Pretibial myxedema with peau d'orange (orange peel) appearance and | Download

★リンクテーブル★

リンク元

「脛骨前粘液水腫」

Pretibial myxedema
	Hands showing related condition thyroid acropachy and Shins of someone with pretibial myxedema
Classification and external resources
ICD-9	242.9
DiseasesDB	25147
eMedicine	derm/347

　　[★]

英: pretibial myxedema　← myx + edema
同: 限局性粘液水腫 circumscribed myxedema　、脛骨前部局所性粘液水腫?

myxedema circumscriptum pretibiale

前脛骨粘液水腫、脛骨前部粘液水腫？
関: ムチン、ムチン症、甲状腺機能亢進症、グレーブス病=バセドウ病

[1] Schwartz, K. M.; Vahab Fatourechi, Debra D. F. Ahmed and Gregory R. Pond (1 February 2002). "Dermopathy of Graves' Disease (Pretibial Myxedema): Long-Term Outcome". Journal of Clinical Endocrinology & Metabolism 87 (2): 438–446. doi:10.1210/jc.87.2.438. Cite uses deprecated parameters (help)

[pmid18337527-2] Prajapati VH, Mydlarski PR (March 2008). "Dermacase. Pretibial myxedema". Can Fam Physician 54 (3): 357, 369. PMC 2278349. PMID 18337527.

[bolognia-3] Rongioletti F, Rebora A (2007). "Mucinoses". In Bolognia JL. Dermatology. St. Louis: Mosby. pp. 616–7. ISBN 1-4160-2999-0.

[4] Harvey, R. D.; Metcalfe, R. A.; Morteo, C.; Furmaniak, W.; Weetman, A. P.; Bevan, J. S. (1 June 1995). "Acute pre-tibial myxoedema following radioiodine therapy for thyrotoxic Graves' disease". Clinical Endocrinology 42 (6): 657–660. doi:10.1111/j.1365-2265.1995.tb02695.x.

[5] PEACEY, S.R.; FLEMMING, L.; MESSENGER, A.; WEETMAN, A.P. (1 February 1996). "Is Graves' Dermopathy a Generalized Disorder?". Thyroid 6 (1): 41–45. doi:10.1089/thy.1996.6.41.

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pretibial myxedema