Published March 28 2016
Pretibial myxedema is a type of skin disorder that occurs in autoimmune thyroid conditions. It is more common in Graves’ Disease, although it can occur in Hashimoto’s Thyroiditis as well (1). It is frequently associated with thyroid eye disease, and is usually characterized by very high levels of TSH receptor antibodies.
With regards to the actual skin lesions, these usually are mild and don’t cause any symptoms. Topical corticosteroids are sometimes prescribed, and while they might help at times, these drugs don’t do anything for the actual cause of the condition. It seems that pretibial myxedema is due to an accumulation of something called glycosaminoglycans in the reticular dermis (2), which is a deeper layer of the skin.
Association with Thyroid Acropachy
Thyroid acropachy is rare, and this condition usually presents with clubbing and swelling of the hand and fingers, along with periosteal reaction (new bone formation) of the extremities (3). Acropachy is mostly associated with pretibial myxedema and ophthalmopathy, and it can occur in both autoimmune hypothyroid and autoimmune hyperthyroid conditions (3). Usually patients will develop eye symptoms first, followed by pretibial myxedema, and finally acropachy (3) (4). Although it might be confused with pretibial myxedema, acropachy usually is characterized by more prominent swelling.
The conventional medical approach involves using either corticosteroids, or systemic immunosuppressive therapy. Once again, these don’t do anything to address the underlying cause of the problem. And so the goal should be to remove the autoimmune trigger and eliminate the inflammatory process.
Incidence In Hashimoto’s Thyroiditis
Although pretibial myxedema is more commonly seen in people with Graves’ Disease, occasionally it is seen in those with Hashimoto’s Thyroiditis. Keep in mind that while Hashimoto’s Thyroiditis is characterized by elevated thyroglobulin antibodies and/or thyroid peroxidase antibodies, some people with Hashimoto’s Thyroiditis also have TSH receptor antibodies. For example, one case study involving a 58-year old woman with Hashimoto’s Thyroiditis who had pretibial myxedema also showed that she had elevated TSH receptor antibodies (5). Another case study involved an 80-year old woman with Hashimoto’s and pretibial myxedema, but she also tested positive for TSH receptor antibodies (6). I came across yet another case report involving someone with Hashimoto’s and pretibial myxedema, and while the test for TSH receptor antibodies couldn’t be done, she has the exophthalmos commonly associated with Graves ophthalmopathy (7).
The Goal Is To Address The Autoimmune Response
Pretibial myxedema frequently resolves spontaneously. However, when someone has Graves’ Disease, with or without pretibial myxedema, the goal should be to address the autoimmune component. As I briefly mentioned earlier, this involves detecting and then removing the autoimmune trigger, and taking steps to eliminate the inflammation. I’ve discussed this in other articles, along with some of my free webinars I offer to the public. However, I would definitely make sure you read the posts “The Role of Cytokines In Autoimmune Thyroid Conditions” and “Regulatory T Cells and Thyroid Autoimmunity“. Removing the trigger and getting rid of the inflammation not only can help with pretibial myxedema, along with other skin conditions, but it can also help with Graves’ ophthalmopathy and thyroid acropachy.
In summary, pretibial myxedema is a type of skin condition that is commonly see in Graves’ Disease, although it can also occur in Hashimoto’s Thyroiditis. Pretibial myxedema is due to an accumulation of something called glycosaminoglycans in the deeper layers of the skin. Conventional treatment usually involves corticosteroids, but from a natural treatment perspective the goal should be to restore the health of the immune system by detecting and removing the autoimmune trigger, as well as reducing the inflammation.