Authors: Nato Tsiklauri , Nino Esakia

Abstract

Background: Graves disease is an autoimmune condition. Simultaneous occurrence of Graves dermopathy and thyroid eye disease is a rare extrathyroidal manifestation. Here we present such a case and its improvement during the treatment.

Case Presentation: A 47-year-old woman with skin rash, pruritus, extremity swelling, tachycardia, proptosis with worsening vision, was previously examined by a dermatologist and was referred to an endocrinologist. She reported lesions on the lower and upper extremities. Laboratory findings revealed the following: suppressed thyroid-stimulating hormone, elevated free thyroxine, elevated anti- thyroid peroxidase, markedly elevated thyrotropin receptor antibodies of >40 IU/L (n≤1.75 IU/L). Skin biopsy demonstrated histopathological findings consistent with thyroid dermopathy. As a result of examination, she was diagnosed with Graves disease and was administered methimazole, pantoprazole, propranolol, prednisolone. Smoking cessation was advised. 1 month after starting treatment, her symptoms had decreased. Among these, the swelling and lesions over the extremities resolved. Only exophthalmos persisted.

Conclusion: The report describes a rare presentation of Graves disease. Because of the atypical morphology and involvement of the forearms, skin biopsy was important in supporting the diagnosis and excluding alternative inflammatory or infiltrative dermatoses

Keywords: Graves dermopathy; thyroid eye disease; atypical localization; thyrotropin receptor antibodies; case report.