Laboratory Studies

Thyroid-stimulating hormone levels may be abnormally high, normal, or low in pretibial myxedema (PTM), depending on whether the underlying thyroid disease has been recognized and treated.

Thyrotropin receptor antibody (TRAB) levels are elevated in about 80-100% of patients with PTM.^[15]

Histologic Findings

The characteristic histopathologic features consist of the deposition of mucin (glycosaminoglycans) throughout the reticular dermis and with attenuation of collagen fibers. Mucin may appear as individual threads and granules. With extensive deposition of mucin, the collagen fibers are frayed, fragmented, and widely separated. Stellate fibroblasts are often observed, but the number of fibroblasts is not increased. The overlying epidermis may show hyperkeratosis. The mucin is hyaluronic acid that stains blue with Alcian-blue at a pH of 2.5 and colloidal iron stains; metachromasia is shown with toluidine blue stain. Findings of mucin deposition restricted to an expanded papillary dermis, nodular angioplasia, and hemosiderin deposition are more suggestive of stasis dermatitis. See the images below.

Deposition of mucin in the reticular dermis (hematoxylin and eosin stain, original magnification X25).

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Blue staining of mucin with colloidal iron stain (original magnification X25).

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Treatment & Management

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Media Gallery

Bilateral erythematous infiltrative plaques in the pretibial areas.
Deposition of mucin in the reticular dermis (hematoxylin and eosin stain, original magnification X25).
Blue staining of mucin with colloidal iron stain (original magnification X25).

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Author

Ranjodh Singh Gill, MD, FACP, CCD Professor of Internal Medicine and Surgery/Endocrinology, Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine

Ranjodh Singh Gill, MD, FACP, CCD is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Physicians, Endocrine Society, International Society for Clinical Densitometry, Medical Society of Virginia, North American Sikh Medical and Dental Association, Richmond Academy of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kathryn K Garner, MD Staff Physician, Family Health Clinic, Ehrling Bergquist Clinic, Offutt AFB, NE

Kathryn K Garner, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Physicians, Uniformed Services Academy of Family Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Purnima Sau, MD Associate Professor, Department of Clinical Dermatology, Uniformed Services University of the Health Sciences

Disclosure: Nothing to disclose.

Laurel R Stearns, DO ResidentPhysician, Department of Dermatology, National Capital Consortium

Laurel R Stearns, DO is a member of the following medical societies: American Academy of Dermatology and Association of Military Osteopathic Physicians and Surgeons

Disclosure: Nothing to disclose.