PRETIBIAL MYXEDEMA IN GRAVES’ DISEASE PRESENTING AS A LOCALIZED THYROID DERMOPATHY

A 53-year old man, on drug treatment for Graves’ disease and ophthalmopathy presented with an enlarged right big toe (Fig. 1). Examination revealed a slightly erythematous diffuse, nontender swelling and non-pitting of the right big toe. An X-ray of the foot demonstrated only soft tissue involvement with no subperiosteal bone formation. The features and clinical context were suggestive of Pretibial myxoedema (thyroid dermopathy) localised to the right big toe nearly 30 years after the presentation of initial Graves’ disease. Biopsy of the lesion was not done as it was aymptomatic and the patient was not willing for one. Pretibial myxoedema is a well-recognised benign complication of Graves’ disease, which may not be restricted to the pretibial area.