Bergersen Tone Kristin, Mørk Cato
Tidsskr Nor Laegeforen. 2009 Apr 16;129(8):750-2. doi: 10.4045/tidsskr.09.34625.
A patient presented with non-pitting lymphoedema of the legs and finger clubbing. A skin biopsy showed epidermal hyperkeratosis and abundant mucinous material (Alcian blue positive) in reticular dermis. Treatment (radioactive iodine) for Grave's disease (with exophthalmus) 20 years ago, raised suspicion of thyroid dermopathy. Together, these three extrathyroidal manifestations of Graves' disease are typical of the EMO syndrome. In addition, the patient had elevated serum concentrations of thyroid-stimulating hormone receptor autoantibodies. Autoimmune mechanisms are involved in the stimulation of fibroblasts and the production of large amounts of mucin. Pretibial myxoedema relates to scars, mechanical factors, and dependent position. Lack of steroid treatment during radioactive iodine therapy and smoking, may have exacerbated the thyroid dermopathy in this case. Awareness of pretibial myxoedema as a late autoimmune manifestation of Graves' disease, may contribute to earlier diagnosis and correct treatment.
一名患者出现腿部非凹陷性淋巴水肿和杵状指。皮肤活检显示表皮角化过度，网状真皮中有大量黏液物质（阿尔辛蓝阳性）。20年前因格雷夫斯病（伴有突眼）接受治疗（放射性碘），这引发了对甲状腺皮肤病的怀疑。格雷夫斯病的这三种甲状腺外表现共同构成了典型的EMO综合征。此外，患者血清中促甲状腺激素受体自身抗体浓度升高。自身免疫机制参与了成纤维细胞的刺激和大量黏蛋白的产生。胫前黏液性水肿与瘢痕、机械因素及下垂体位有关。在该病例中，放射性碘治疗期间未使用类固醇治疗以及吸烟，可能加剧了甲状腺皮肤病。认识到胫前黏液性水肿是格雷夫斯病的一种晚期自身免疫表现，可能有助于早期诊断和正确治疗。
