Presentation
Loss of weight, tremors, lower limb showing pretibial myxoedema (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
Diffuse thyroid gland enlargement.
Altered parenchymal echotexture and decreased echogenicity. Absence of nodularity.
Marked increased vascularity (thyroid inferno pattern).
X-ray AP of both legs shows osteopenia.
Pretibial, ankles, and feet soft tissue swelling bilaterally (myxoedema).
Soft tissue ultrasonography of both legs shows subcutaneous oedema.
Lower limbs showing pretibial myxoedema (graves dermopathy).
Case Discussion
Graves disease (also known as diffuse toxic goitre) 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 colour Doppler ultrasonography, there is an increase in vascularisation of the parenchyma, this appearance is known as a "thyroid inferno".
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