Thyroid inferno (Graves disease)

Case contributed by Mohammad Osama Hussein Yonso
Diagnosis certain


Loss of weight, tremors, lower limb showing pretibial myxedema (second degree), severe itching, and a pulse of 106. He was diagnosed with thyrotoxicosis 1 years ago and was put on Carbimazole 5 mg. No treatment in the last 2 months.

Patient Data

Age: 50 years
Gender: Male

Thyroid USG


Diffuse thyroid gland enlargement.

Altered parenchymal echotexture and decreased echogenicity. Absence of nodularity.

Marked increased vascularity (thyroid inferno pattern).

Legs X-ray


X-ray AP of both legs shows osteopenia.

Pretibial, ankles, and feet soft tissue swelling bilaterally (myxedema).

Legs soft tissue USG


Soft tissue ultrasonography of both legs shows subcutaneous edema.


Lower limbs showing pretibial myxedema (graves dermopathy).

Case Discussion

Graves disease (also known as diffuse toxic goiter) is an autoimmune disorder caused by antibodies against the thyrotropin (TSH) receptors on the cell surface of the thyroid follicle. By mimicking TSH, the thyroid receptor antibodies excessively stimulate the thyroid cells, which in turn increases thyroid hormone production with its associated sequelae.

Thyroid ultrasound demonstrates an enlarged gland that has characteristic echogenicity, easily distinguishable from adjacent muscular structures.

On color Doppler ultrasonography, there is an increase in vascularization of the parenchyma, this appearance is known as a "thyroid inferno".

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