Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 3708       

   Table of Contents      
CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 140-141

Grave's disease: Classical triad & response to treatment


Department of Dermatology, Venereology & Sexually Transmitted Diseases, University College of Medical Sciences & Guru Tegh Bahadur Hospital, Delhi 110 095, India

Date of Submission19-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Archana Singal
Department of Dermatology, Venereology & Sexually Transmitted Diseases, University College of Medical Sciences & Guru Tegh Bahadur Hospital, Delhi 110 095
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2225_19

Rights and Permissions

How to cite this article:
Agrawal S, Singal A. Grave's disease: Classical triad & response to treatment. Indian J Med Res 2020;152, Suppl S1:140-1

How to cite this URL:
Agrawal S, Singal A. Grave's disease: Classical triad & response to treatment. Indian J Med Res [serial online] 2020 [cited 2021 Aug 4];152, Suppl S1:140-1. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/140/316783

Patient's consent obtained to publish clinical information and images.


A 44 yr old male, presented to the department of Dermatology, Venereology & Sexually Transmitted Diseases, University College of Medical Sciences and Guru Teg Bahadur (UCMS & GTB) Hospital, Delhi, India, in February 2019, with symmetrical, brown plaques having peau-d' orange appearance bilaterally over the anterior aspect of lower legs [Figure 1]A. He also had exophthalmos [Figure 2] and thyroid acropachy [Figure 3]. Laboratory tests showed high levels of anti-thyroid peroxidase antibodies (112 IU/ml) and thyroid profile indicative of Grave's disease. Histopathological [Figure 4] examination of punch biopsy from the leg lesions, showed features consistent with pretibial myxoedema. The patient was started on oral propranolol and carbimazole. Pretibial lesions were treated with topical high potent corticosteroids under occlusion and intralesional corticosteroid injections (20 mg/ml) at four weekly intervals. At six months follow up there was a significant improvement in texture and appearance of the plaques [Figure 1]B. Grave's disease presents with a triad of exophthalmos, myxoedema and acropachy in <1% population. Pretibial myxedema is an infrequent manifestation of Grave's disease accounting for <5% of cases. The present case depicts Grave's disease with the classical triad of pretibial myxoedema, ophthalmopathy and thyroid acropachy managed successfully on medications and topical as well as intralesional steroids.
Figure 1: (A) Symmetrical, brown plaques with peau-d' orange appearance over bilateral lower legs suggestive of pretibial myxoedema. (B) Post-treatment image showing a remarkable reduction in the thickness of the plaques and improvement in texture.

Click here to view
Figure 2: Bilateral proptosis suggestive of thyroid ophthalmopathy.

Click here to view
Figure 3: Pan digital clubbing (arrows) as a manifestation thyroid acropachy.

Click here to view
Figure 4: Histopathology from the plaques on haematoxylin and eosin stain (×40) showing large deposits on mucin in the reticular dermis (*), separating collagen fibres.

Click here to view


Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Article Figures

 Article Access Statistics
    Viewed136    
    Printed0    
    Emailed0    
    PDF Downloaded26    
    Comments [Add]    

Recommend this journal