Salvi M, De Chiara F, Gardini E, Minelli R, Bianconi L, Alinovi A, Ricci R, Neri F, Tosi C, Roti E
Cattedra di Endocrinologia, Università di Parma, Italy.
Eur J Endocrinol. 1994 Aug;131(2):113-9. doi: 10.1530/eje.0.1310113.
In the present study we have evaluated the use of pretibial ultrasound for the diagnosis of pretibial myxedema (PTM). We studied 76 patients, 58 with Graves' disease, 13 with Hashimoto's thyroiditis and five with idiopathic hypothyroidism. Thirty-two normal subjects were also studied as controls. Sixty-four patients had associated ophthalmopathy. The ultrasound scanner was equipped with 10- and 13-MHz probes. Punch biopsies were carried out in 11 patients and tissue sections examined on a light microscope. On clinical examination 21 patients (28%) had suspected PTM. By ultrasound, we measured the thickness of dermis and subcutaneous tissue (D1) and that including only deeper dermis (D2) in normal subjects to define the echographic parameters of normal pretibial skin. We then found increased skin thickness in 25 patients (33%), with mean D1 and D2 values significantly higher than those measured in controls (p < 0.00001). The echographic study was positive in 20 patients with ophthalmopathy (31%). Ultrasound showed increased skin thickness in 16 of 21 patients (76%) with clinically suspected PTM. Histopathological findings confirmed the presence of PTM in all the patients who underwent pretibial skin biopsy. We believe that the measurement of pretibial skin thickness by ultrasound may be useful for revealing the presence of PTM.
在本研究中，我们评估了胫前超声在胫前黏液性水肿（PTM）诊断中的应用。我们研究了76例患者，其中58例患有格雷夫斯病，13例患有桥本甲状腺炎，5例患有特发性甲状腺功能减退症。还研究了32名正常受试者作为对照。64例患者伴有眼病。超声扫描仪配备了10兆赫和13兆赫的探头。对11例患者进行了钻孔活检，并在光学显微镜下检查组织切片。临床检查发现21例患者（28%）疑似患有PTM。通过超声，我们测量了正常受试者的真皮和皮下组织厚度（D1）以及仅包括更深层真皮的厚度（D2），以确定正常胫前皮肤的超声参数。然后我们发现25例患者（33%）的皮肤厚度增加，其平均D1和D2值显著高于对照组（p < 0.00001）。超声检查在20例患有眼病的患者中呈阳性（31%）。超声显示，21例临床疑似PTM的患者中有16例（76%）皮肤厚度增加。组织病理学检查结果证实了所有接受胫前皮肤活检的患者均存在PTM。我们认为，通过超声测量胫前皮肤厚度可能有助于发现PTM的存在。
