Hyperthyroid-associated EMA syndrome: four cases report and review of literature

Abstract

Four patients with hyperthyroid-associated exophthalmos, myxedema, acropachy(EMA)syndrome, including three male patients and one female patient were diagnosed with Graves' diseases and treated by 131I therapy. Complaints of thyrotoxicosis were presented at the onset. Tibia myxedema and acropathy appeared, and eye symptoms aggravated in two patients after anti-thyroid drug therapy and 131I therapy. Four cases were all given clobetasol propionate, miconazole nitrate, neomycin sulfate and urea cream alone or in combination with compound betamethasone local injection treatment, and three cases were given low-dose oral prednisone treatment. Complaints of tibia myxedema and eye symptoms were significantly improved after the treatment. Therefore, we should be wary of the occurrence of hyperthyroid-associated EMA syndrome after 131I therapy. Corticosteroid might be the effective therapy for myxedema and eye symptoms of EMA syndrome.(Chin J Endocrinol Metab, 2015, 31: 790-792) Key words: Hyperthyroidism; EMA syndrome; Anterior tibial myxedema; Topical hormone therapy