Abstract
IntroductionGraves’ hyperthyroidism has a number of well-recognized but relatively rare extrathyroid manifestations such as thyroid acropachy, pretibial myxedema, and congestive heart failure.Case presentationA 38-year-old Caucasian woman presented to the out-patient clinic with symptoms of hyperthyroidism lasting for approximately five months. Remarkably, she had developed pitting edema of her left leg four months before. She had gone through a conventional assessment, but the reason for the edema was not revealed. At presentation to the endocrinology clinic, the skin of both legs was of normal color and pitting edema on her left leg was of a diffuse nature and spread from her toes to two thirds of her leg. The skin surface of her left leg was smooth and had no elevations or discoloration, whereas her right leg appeared normal. Based on signs and symptoms of thyrotoxicosis and suppressed thyroid-stimulating hormone level (less than 0.001mIU/L, local reference of 0.4 to 4), treatment of 10mg of thiamazole three times a day was started. Additional blood tests revealed marked Graves’ hyperthyroidism with elevated free T4 and anti-thyroid receptor antibodies. Within a month, the free T4 level was normalized and the edema was completely cleared and never reappeared during the treatment course of 12 months.ConclusionsTo the best of our knowledge, this is the first description of unilateral treatment-responsive leg edema as a manifestation of Graves’ hyperthyroidism. However, the pathophysiological mechanism underlying this case of edema remains unclear.
Highlights
Graves’ hyperthyroidism has a number of well-recognized but relatively rare extrathyroid manifestations such as thyroid acropachy, pretibial myxedema, and congestive heart failure.Case presentation: A 38-year-old Caucasian woman presented to the out-patient clinic with symptoms of hyperthyroidism lasting for approximately five months
To the best of our knowledge, this is the first description of unilateral treatment-responsive leg edema as a manifestation of Graves’ hyperthyroidism
The pathophysiological mechanism underlying this case of edema remains unclear
Summary
Graves’ disease may have various manifestations involving lower extremities. Graves’ dermopathy is a wellrecognized entity that can appear as typical pretibial myxedema (57%) or plaques (21%) or rarely as nodular lesions or elephantiasis [1]. Case presentation A 38-year-old Caucasian woman presented to the outpatient clinic with symptoms of hyperthyroidism lasting for around five months. She had lost approximately 3kg and had noticed irritability and mild hand tremor. Signs of thyrotoxicosis were moderate: hand tremor, tachycardia (95 beats per minute), and warm skin were apparent Her thyroid was smooth, had a slightly increased volume, and was not tender on palpation. There was no eye involvement except mild periorbital edema of her left eye She had developed painless pitting edema of the left leg four months before. The edema never reappeared during the treatment course of 12 months
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