Treatment of Pretibial Myxedema (PTM) with Topical Steroid Ointment Application with Sealing Cover (Steroid Occlusive Dressing Technique: Steroid ODT) in Graves Patients

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Localized pretibial myxedema (PTM) is a sign of Graves disease. A 53-year-old man with Graves disease was admitted with the development of PTM following radioisotope 131I treatment for Graves hyperthyroidism. TSH receptor antibody (TRAb) titer was also increased after 131I treatment. TRAb was measured as thyroid stimulating antibody (TSAb) or TSH-binding inhibitory immunoglobulin (TBII). PTM was noted several months after 131I treatment. The PTM-development seems to be associated with the increased TRAb-activities. The localized pretibial myxedema was effectively treated with topical steroid (triamcinolone acetonide) ointment application with sealing cover (steroid occlusive dressing technique: steroid ODT). We also report our experience of PTM-treatment with steroid ODT in 5 other PTM patients with positive TRAb. PTM was successfully treated with steroid ODT in two patients. In these two patients, the treatment was started within several months of the appearance of PTM. In the other 4 patients, the treatment was started 5-10 years after the appearance of PTM without any beneficial effects. Early detection and early treatment are necessary for the remission of PTM.