Pretibial myxedema: pathogenetic features and clinical aspects

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Pretibial myxedema (PTM) or thyroid dermopathy is a rare extrathyroidal manifestation of Graves’ disease. The condition is accompanied by mucinous skin changes, mainly in the anterior tibial surface.

Severe forms may lead to lymphatic congestion and disability. Prolonged and intense autoimmune aggression is supposed to be necessary for PTM manifestation. However, data on the role of TSHR antibodies in the development of thyroid dermopathy are very ambiguous; evidence of IGF-1 receptor involvement in the pathogenesis was reported recently.

Typically, PTM is localized on the anterior and lateral surfaces of both tibias and can be represented by diffuse, tumorous, plaque-like, or elephantiasic forms. Currently, early diagnostics involves regular preventive examination of the pretibial area. A diagnostic biopsy is indicated only in complex cases.

Maintaining euthyroidism, smoking cessation, preventing injuries, and avoiding tight shoes that disturb lymphatic drainage are measures reducing the risk of PTM in GD patients.

Currently, there are no accepted clinical guidelines for the diagnosis and treatment of thyroid dermopathy. This review provides the recent scientific data on etiopathogenesis and management of patients with PTM.

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About the authors

Ekaterina A. Sabanova

I.M. Sechenov First Moscow State Medical University (Sechenov University); Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology

Author for correspondence.
ORCID iD: 0000-0002-5402-9795
SPIN-code: 4698-2260

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992; 1, Pogodinskaya str., Moscow, 119435


Valentin V. Fadeyev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID iD: 0000-0002-3026-6315
SPIN-code: 6825-8417

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD, PhD, Professor

Nikolai N. Potekaev

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology

ORCID iD: 0000-0002-9331-7714
SPIN-code: 8862-5688

Russian Federation, 20, Seleznevskaya str., Moscow, 127473

MD, PhD, Professor

Andrey N. Lvov

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology

ORCID iD: 0000-0002-3875-4030
Scopus Author ID: 26432035300

Russian Federation, 20, Seleznevskaya str., Moscow, 127473

MD, PhD, Professor


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Supplementary files

Supplementary Files Action
Fig. 1. Interaction of receptors for TSH and IGF-1.

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Fig. 2. Plaque and diffuse forms of pretibial myxedema.

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Fig. 2. Plaque and diffuse forms of pretibial myxedema. Figure. 3. The histological picture of the pretibial myxedema. and - coloring by hematoxylin and eosin, × 100; b - coloring by hematoxylin and eosin, × 200.

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Copyright (c) 2019 Sabanova E.A., Fadeyev V.V., Potekaev N.N., Lvov A.N.

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