Response of a Patient with Severe Thyroid Dermopathy to Combined Multipoint Subcutaneous Injection of Glucocorticoids and Local Excision
Response of a Patient with Severe Thyroid Dermopathy to Combined Multipoint Subcutaneous Injection of Glucocorticoids and Local Excision
复制标题
严重甲状腺皮肤病患者联合多点皮下注射糖皮质激素和局部切除的反应
作者：
Huang Yingshi;Wei Chiju;Ma Shuhua;Fu Yucai;Xu Wencan
尊敬的编辑：一位56岁男性，有10年突眼病史和5年甲状腺皮肤病病史，被收入内分泌科。他是一个在家乡工作的农民。10年前，他出现小甲状腺肿、轻度心悸和眼球突出（20 mm），在当地医院被诊断为Graves病和甲状腺相关眼病。患者接受丙基硫氧嘧啶治疗。然后他逐渐发展成复视。经过五年的抗甲状腺药物治疗后，他接受了放射性碘治疗。随后，他的眼球突出加重（23 mm），并出现轻度眼恐怖症和结膜充血。他的甲状腺功能检查显示，他已发展为甲状腺功能减退症，患者开始接受左旋甲状腺素（125 lg/天）和泼尼松（剂量未知）治疗。出乎意料的是，他随后在身体的某些部位出现了多个隆起的疣状斑块。皮肤活检显示这些病变中有大量的糖胺聚糖沉积，并诊断为甲状腺皮肤病。近3年来，经停用强的松治疗后，皮肤病有所好转，但双眼畏光、复视仍持续，入院后体检发现足部、手背、上背部有隆起的疣状斑块（图1：治疗前）。还存在双手的肢端疼痛。观察到明显眼球突出伴上眼睑退缩，但眼睑正常闭合，以及结膜充血。他的左眼和右眼视力分别为0.6和0.8。眼球运动正常。经左旋甲状腺素125 lg、强的松30 mg/d治疗1周后，恐怖症有所改善。在接下来的五个月里，左旋甲状腺素剂量逐渐减少到50 lg，他保持甲状腺功能正常。泼尼松减少至10 mg/d。患者每月接受两次右肩斑块局部切除术，然后每月接受五次足部病变切除术。
Dear Editor: A 56-year-old man, with a 10-year history of exophthalmos and five-year history of thyroid dermopathy, was admitted to the endocrinology department. He was a farmer working in his hometown. Ten years earlier, he presented with a small goiter, mild palpitations, and exophthalmos (20 mm), and he was diagnosed with Graves’ disease and thyroid-associated opthalmopathy in a local hospital. He was treated with propylthiouracil. He then gradually developed diplopia. After a five-year period of antithyroid medication, he received radioactive iodine treatment. Subsequently, his exophthalmos became worse (23 mm), and he developed mild photophobia and conjunctival injection. His thyroid function tests revealed that he had developed hypothyroidism, and the patient was started on levothyroxine (125 lg per day) and prednisone (dose not known). Unexpectedly, he subsequently developed multiple ridgy verruca-like plaques in some regions of his body. A skin biopsy showed abundant deposition of glycosaminoglycans in these lesions, and a diagnosis of thyroid dermopathy was established. During the past three years, after withdrawal of prednisone treatment, his dermopathy improved to some extent, but the photophobia and diplopia of both eyes persisted.After admission to our department, physical examination revealed ridgy verruca-like plaques on his feet, the dorsa of the hands, and the upper back (Fig. 1: before treatment). Acropachy of both hands was also present. Apparent exophthalmos with retraction of the upper eyelids but with normal closing of the eyelids, as well as conjunctival injection, were noted. The vision of his left and right eyes was 0.6 and 0.8, respectively. Ocular movements were normal. He was treated with 125 lg of levothyroxine and 30mg of prednisone daily for one week, and the photophobia improved to some extent. During the next five months, the levothyroxine dose was gradually reduced to 50 lg, and he remained euthyroid. The prednisone was reduced to 10mg daily. The patient underwent monthly local excisions of the plaques on the right shoulder on two occasions, and he then underwent five monthly excisions of the lesions on his feet.