Elephantiasic Pretibial Myxoedema in a Patient with Graves’ Disease


Pretibial myxoedema (PM) is a late and rare manifestation of autoimmune thyroiditis, particularly in patients with Graves’ disease. It occurs in 0.5% to 4.3% of patients [1], and is usually associated with high levels of thyroid hormones. The classification of PM includes four forms: non-pitting edema; plaque; nodular; or elephantiasis [1]. Mild PM often regresses spontaneously, but the severe, elephantiasic variant is typically progressive and refractory to treatment. Elephantiasic pretibial myxoedema (EPM) is characterized by massive edema, skin fibrosis and verrucous nodule formation, and it clinically resembles lymphedema. Herein, we describe a man with Graves’ disease presenting with EPM for nearly 2 years. Although advanced cases have been described in the literature, to our knowledge, none have reached this level of severity.

Share and Cite:

Zhang, R. , Yang, Y. and Zhu, W. (2015) Elephantiasic Pretibial Myxoedema in a Patient with Graves’ Disease. Journal of Cosmetics, Dermatological Sciences and Applications, 5, 297-299. doi: 10.4236/jcdsa.2015.54036.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Chen, C.T. and Lin, J.C. (2013) Elephantiasic Pretibial Myxoedema. Indian Journal of Medical Research, 137, 568.
[2] Fatourechi, V., Pajouhi, M. and Fransway, A.F. (1994) Dermopathy of Graves Disease (Pretibial Myxedema): Review of 150 Cases. Medicine (Baltimore), 73, 1-7.
[3] Rapoport, B., Alsabeh, R., Aftergood, D. and McLachlan, S.M. (2000) Elephantiasic Pretibial Myxedema: Insight into and a Hypothesis Regarding the Pathogenesis of the Extrathyroidal Manifestations of Graves’ Disease. Thyroid, 10, 685-692.
[4] Heyes, C., Nolan, R., Leahy, M. and Gebauer, K. (2012) Treatment-Resistant Elephantiasic Thyroid Dermopathy Responding to Rituximab and Plasmapheresis. Australasian Journal of Dermatology, 53, e1-e4.
[5] Yu, H., Jiang, X., Pan, M. and Huang, R. (2014) Elephantiasic Pretibial Myxoedema in a Patient with Graves’ Disease That Resolved after 131I Treatment. Clinical Nuclear Medicine, 39, 758-759.
[6] Susser, W.S., Heermans, A.G., Chapman, M.S. and Baughman, R.D. (2002) Elephantiasic Pretibial Myxedema: A Novel Treatment for an Uncommon Disorder. Journal of the American Academy of Dermatology, 46, 723-726.
[7] Dhaille, F., Dadban, A., Meziane, L., Fessier, C., Colta, L., Lok, C., et al. (2012) Elephantiasic Pretibial Myxoedema with Upper-Limb Involvement, Treated with Low-Dose Intravenous Immunoglobulins. Clinical and Experimental Dermatology, 37, 307-308.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.