ABSTRACT
INTRODUCTION: Graves' orbitopathy (GO), thyroid dermopathy (also called pretibial myxedema) and acropachy are the extrathyroidal manifestations of Graves' disease. They occur in 25, 1.5, and 0.3 % of Graves' patients, respectively. Thus, GO is the main and most common extrathyroidal manifestation. Dermopathy is usually present if the patient is also affected with GO. The very rare acropachy occurs only in patients who also have dermopathy. GO and dermopathy have an autoimmune origin and are probably triggered by autoimmunity to the TSH receptor and, likely, the IGF-1 receptor. Both GO and dermopathy may be mild to severe. MANAGEMENT: Mild GO usually does not require any treatment except for local measures and preventive actions (especially refraining from smoking). Currently, moderate-to-severe and active GO is best treated by systemic glucocorticoids, but response to treatment is not optimal in many instances, and retreatments and use of other modalities (glucocorticoids, orbital radiotherapy, cyclosporine) and, in the end, rehabilitative surgery are often needed. Dermopathy is usually managed by local glucocorticoid treatment. No specific treatment is available for acropachy. PERSPECTIVES: Novel treatments are presently being investigated for GO, and particular attention is paid to the use of rituximab. It is unknown whether novel treatments for GO might be useful for the other extrathyroidal manifestations. Future novel therapies shown to be beneficial for GO in randomized studies may be empirically used for dermopathy and acropachy.
Subject(s)
Graves Disease/physiopathology , Graves Ophthalmopathy/etiology , Leg Dermatoses/etiology , Myxedema/etiology , Osteoarthropathy, Secondary Hypertrophic/etiology , Precision Medicine , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Autoimmunity/drug effects , Combined Modality Therapy , Disease Progression , Graves Disease/drug therapy , Graves Disease/immunology , Graves Disease/therapy , Graves Ophthalmopathy/epidemiology , Graves Ophthalmopathy/prevention & control , Humans , Leg Dermatoses/prevention & control , Myxedema/epidemiology , Myxedema/prevention & control , Osteoarthropathy, Secondary Hypertrophic/epidemiology , Osteoarthropathy, Secondary Hypertrophic/prevention & control , Risk FactorsABSTRACT
A 54-year-old man with bronchogenic adenocarcinoma had features of the hypertrophic osteoarthropathy syndrome. The syndrome is treated by surgical resection of the primary tumor, with rapid remission of the symptoms within 24 hours after surgery. In the case reported here, the tumor (T3N3M0) could not be resected. Clinical and scintigraphic regression of the hypertrophic osteoarthropathy was evident after chemotherapy. Bone scintigraphy is valuable when determining a patient's response to treatment for this paraneoplastic syndrome.
