Pretibial Myxedema and Nonthyrotoxic Thyroid Disease

Four patients had a distinct variant of exophthalmic goiter (Graves' disease) characterized by pretibial myxedema and nonthyrotoxic thyroid disease. A review of literature revealed 19 cases with similar findings. All were adults and two thirds were women. Exophthalmos and acropachy were present. One third were hypothyroid and the rest were euthyroid at the time the pretibial myxedema, exophthalmos, and acropachy developed. None had ever had signs or symptoms of hyperthyroidism. Long-acting thyroid stimulator (LATS) was present in all cases in which it was sought. Even though a hypermetabolic state was not present in these patients, the occurrence of dermopathy, opthalmopathy, and LATS furnished three of the four components of Graves' disease. Present evidence suggests that the thyroid disease in the patients, whether it be primary hypothyroidism or thyroiditis, is etiologically closely related to the diffuse toxic goiter of Graves' disease.