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Journal of General and Emergency Medicine

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Editorial

Pre-Dorsal Myxedema: A Rare Unique Manifestation of Hypothyroidism in an Egyptian Female Patient

Mina T. Kelleni

Correspondence Address :

Mina T. Kelleni
Pharmacology Department
Faculty of medicine Minia University
Egypt
Tel: (+20) 1200382422
Email: drthabetpharm@yahoo.com

Received on: November 23, 2016, Accepted on: November 30, 2016, Published on: December 7, 2016

Citation: Mina T. kelleni (2016). Pre-Dorsal Myxedema: A Rare Unique Manifestation of Hypothyroidism in an Egyptian Female Patient

Copyright: 2016 Mina T. kelleni. This is an openaccess article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Fulltext
A 45 years old female patient came to my clinic wishing to lose some weight (90 Kg; 163 cm height). Upon history taking I've realized that she's not eating extra calories to explain this weight gain and she's not living a sedentary life. Upon examination, I've noticed the three years old bilateral dorsal leg non-pitting swelling (Figure 1) to which she heard multiple diagnoses e.g. suspected elephantiasis and a post cholecystectomy complication! She's been given diuretics to relieve this swelling in vain. I've suspected a thyroid gland disorder and she's described chronic and easy fatigability, dyspnea on moderate exertion, somnolence while her ECG was within normal limits. I've asked for thyroid profile and the lab results were very particular. Severe hypothyroidism was revealed (TSH > 150 mcIU/ml; Free T3 0.5 pg/ml; Free T4 0.2 ng/dl) As a physician as well as a pharmacologist, I've seen some cases with the famous pretibial myxedema which was referenced to occur in 4.3% of patients with Graves's disease mainly in the pretibial areas as well as on the dorsum of the foot [1]. Further, rare presentation of myxedema of the hand, elbow, arm, and forearm were referenced and even a 4 years old non-pitting edema of the toe with no involvement of the pretibial portion was described before [2]. However, the term myxedema has been also used to refer to the thickened, nonpitting edematous changes to the soft tissues of patients in a markedly hypothyroid state. To the best of my knowledge, this case is the first localized predorsal foot myxedema to be described with hypothyroidism; the patient didn't describe any symptoms to suggest previous hyperthyroidism. I've prescribed the generic T4 commercially available in Egypt and I've increased the dose gradually over two weeks to 150 mg/day; dramatic decrease in the left leg dorsal swelling was noticed at the end of the first week (Figure 2) though I've told the patient that the swelling may take months to decrease, if ever decreased! All the symptoms of hypothyroidism have also improved dramatically improving the quality of life of the patient and she experienced a 3 Kg weight loss in ten days and she's feeling great.
References
1. Gopie P, Naraynsingh V. Severe pretibial myxedema. The international journal of lower extremity wounds. 2011; 10(2): 91-92.
2. Hasani-Ranjbar S, Mohajeri-Tehrani MR. Localized myxedema of the toe: a rare presentation of graves' dermopathy. Archives of Iranian medicine. 2008;11(3): 326-329.

Tables & Figures
Figure 1 and 2: Pre-dorsal myxedema before and after 1 week of thyroid hormone administration.
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