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.
Introduction: Rare and special manifestations of Graves disease-recurrent big toe mass, cut or not cut? Case description The patient underwent total thyroidectomy due to Graves' disease at the age of 47
.
After 8 years of levothyroxine treatment, a lump with a diameter of about 3 cm appeared on the big toe of the left foot, which was diagnosed as localized mucoedema and was removed
.
Two years later, when the patient was 57 years old, the lesion recurred locally (Figure 1A).
On physical examination, the patient was accompanied by orbital disease.
There was no sign of anterior tibial mucus edema.
The lesion showed a soft and movable mass on the dorsal side of the hallux
.
MRI showed T2-weighted high signal and unclear boundaries.
In order to confirm the skin lesions and exclude soft tissue tumors, the doctor reviewed the tissue sections saved during the previous operation
.
Hematoxylin-eosin staining showed that weak basophilic acellular substances caused diffuse widening of the reticular dermis (associated with isolated lymphocytes), separation of collagen fibers and spreading around blood vessels and appendages.
The microscopic features were similar to mucopolysaccharides.
The sedimentary disease is consistent
.
In this regard, the initial diagnosis-localized mucin edema-was confirmed, and it was believed that the current lesion was caused by recurrence, and the patient was referred to conservative treatment
.
Note: A: Recurrent masses on the big toe; B: MRI showed T2-weighted high signal with unclear borders; C/D: hematoxylin-eosin staining results (C, 40 times; D 200 times) Figure 1 Localized mucus Is the clinical, magnetic resonance imaging, and histological manifestations of sexual edema true or not? It is recommended to treat conservatively, not cut
.
In terms of clinical symptoms, approximately 25% of patients with Graves disease have invasive eye disease, and less than 5% of patients may have thyroid-related skin diseases
.
➤Although mucoedema usually occurs on the anterolateral side of the calf (pretibial mucin edema), it can also occur in other areas, especially after local trauma; ➤In addition, Graves disease-related skin lesions and orbital lesions can also occur in thyroid surgery After radioactive iodine treatment or in patients with clinically normal thyroid function; ➤Mucous edema usually does not require treatment.
Considering the possibility of recurrence, surgical resection is not recommended (such as this case).
➤It needs to be accepted due to appearance or wearing shoes.
For treatment, topical glucocorticoids administered under occlusive dressings may be beneficial
.
Summary Limitations and nodular mucinous edema is a rare Graves disease-related skin disease.
Although the appearance of this case may cause people's attention, the clinical manifestations and histological evidence suggest that conservative treatment should be given
.
Yimaitong compiled and compiled from: Renne SL, Valeri M, Radaelli S, et al.
A recurrent mass on the big toe[J].
Lancet Diabetes Endocrinol, 2020, 8 (10): 868.
.
Introduction: Rare and special manifestations of Graves disease-recurrent big toe mass, cut or not cut? Case description The patient underwent total thyroidectomy due to Graves' disease at the age of 47
.
After 8 years of levothyroxine treatment, a lump with a diameter of about 3 cm appeared on the big toe of the left foot, which was diagnosed as localized mucoedema and was removed
.
Two years later, when the patient was 57 years old, the lesion recurred locally (Figure 1A).
On physical examination, the patient was accompanied by orbital disease.
There was no sign of anterior tibial mucus edema.
The lesion showed a soft and movable mass on the dorsal side of the hallux
.
MRI showed T2-weighted high signal and unclear boundaries.
In order to confirm the skin lesions and exclude soft tissue tumors, the doctor reviewed the tissue sections saved during the previous operation
.
Hematoxylin-eosin staining showed that weak basophilic acellular substances caused diffuse widening of the reticular dermis (associated with isolated lymphocytes), separation of collagen fibers and spreading around blood vessels and appendages.
The microscopic features were similar to mucopolysaccharides.
The sedimentary disease is consistent
.
In this regard, the initial diagnosis-localized mucin edema-was confirmed, and it was believed that the current lesion was caused by recurrence, and the patient was referred to conservative treatment
.
Note: A: Recurrent masses on the big toe; B: MRI showed T2-weighted high signal with unclear borders; C/D: hematoxylin-eosin staining results (C, 40 times; D 200 times) Figure 1 Localized mucus Is the clinical, magnetic resonance imaging, and histological manifestations of sexual edema true or not? It is recommended to treat conservatively, not cut
.
In terms of clinical symptoms, approximately 25% of patients with Graves disease have invasive eye disease, and less than 5% of patients may have thyroid-related skin diseases
.
➤Although mucoedema usually occurs on the anterolateral side of the calf (pretibial mucin edema), it can also occur in other areas, especially after local trauma; ➤In addition, Graves disease-related skin lesions and orbital lesions can also occur in thyroid surgery After radioactive iodine treatment or in patients with clinically normal thyroid function; ➤Mucous edema usually does not require treatment.
Considering the possibility of recurrence, surgical resection is not recommended (such as this case).
➤It needs to be accepted due to appearance or wearing shoes.
For treatment, topical glucocorticoids administered under occlusive dressings may be beneficial
.
Summary Limitations and nodular mucinous edema is a rare Graves disease-related skin disease.
Although the appearance of this case may cause people's attention, the clinical manifestations and histological evidence suggest that conservative treatment should be given
.
Yimaitong compiled and compiled from: Renne SL, Valeri M, Radaelli S, et al.
A recurrent mass on the big toe[J].
Lancet Diabetes Endocrinol, 2020, 8 (10): 868.