Endocrinology Department, Guangzhou General Hospital of Guangzhou Military Command Region, Guangzhou, China.
Thyroid. 2011 Jan;21(1):83-5. doi: 10.1089/thy.2010.0268. Epub 2010 Dec 16.
Pretibial myxedema (PM) is an uncommon and characteristic manifestation of Graves' disease (GD), with local autoimmune reaction in cutaneous tissue. The treatment of PM is a clinical challenge. We herein report a patient with PM who achieved complete remission by multipoint subcutaneous injection of long-acting glucocorticid.
A 38-year-old man presented with an 18-month history of GD and a 1-year history of PM. Physical examination revealed mildly prominent eyes, diffuse enlargement of the thyroid gland, and PM of both lower extremities. The patient was treated with triamcinolone acetonide by multipoint subcutaneous injections in a combined dose of 20 mg in each lower extremity administered every 25-28 days. The injection was started from the borderline of the lesions and normal skin by selecting 4 to 5 points per leg for each course and then moving to other parts in subsequent courses of treatment. The depth of needle insertion was 0.5-1.0 cm. The patient's PM achieved complete remission in both lower extremities after an approximately 6-month period that included seven courses of treatment with a total dosage of 280 mg triamcinolone acetonide.
Our experience with this patient suggests that multipoint subcutaneous injection of long-acting glucocorticid is a safe, effective, and convenient treatment of PM in patients with GD.
胫前黏液水肿（PM）是 Graves 病（GD）的一种不常见且特征性表现，为皮肤组织的局部自身免疫反应。PM 的治疗是临床挑战。我们在此报告一例 PM 患者，经长效糖皮质激素多点皮下注射实现完全缓解。
一名 38 岁男性，有 18 个月 GD 病史和 1 年 PM 病史。体格检查显示轻度突眼、甲状腺弥漫性肿大和双下肢 PM。患者接受曲安奈德多点皮下注射治疗，每侧下肢总剂量为 20mg，每 25-28 天注射一次。注射从病变边界和正常皮肤开始，每条腿选择 4 到 5 个点，每个疗程后再转移到治疗的其他部位。针插入深度为 0.5-1.0cm。在大约 6 个月的时间里，7 个疗程共使用了 280mg 曲安奈德，患者的 PM 双侧下肢完全缓解。
我们对该患者的经验表明，长效糖皮质激素多点皮下注射是 GD 患者 PM 的一种安全、有效、方便的治疗方法。
