Pretibial Myxedema and Thyroid Eye Disease

There are many health conditions linked with thyroid eye disease (TED), an autoimmune disease that affects the tissue around the eyes. These conditions include high blood pressure, diabetes, and other autoimmune diseases. Autoimmune diseases occur when the immune system overreacts and attacks healthy tissue.1

There are also some conditions that may be linked with TED, but experts are not certain how they are related. One such example is pretibial myxedema.1,2

What is pretibial myxedema?

Pretibial myxedema is a skin condition that can develop in people with Graves’ disease. It also may be called:2

  • Localized myxedema
  • Thyroid dermopathy
  • Graves' dermopathy
  • Infiltrative dermopathy

Pretibial myxedema causes red, swollen skin. The skin texture may change and become bumpy. This texture can feel similar to an orange peel. The condition is most likely to affect the skin on the shins or the tops of the feet. But it is not limited to these spots. Some people have it on the elbows, knees, upper back, or neck.2,3

Pretibial myxedema causes discomfort and changes the appearance of the skin. For some people, it makes it hard to fit shoes on their feet.2,3

What is the link between pretibial myxedema and thyroid eye disease?

Graves’ disease is an autoimmune disease that can lead to TED in some people. Graves’ disease causes the body to overproduce thyroid hormones. About 1 in 3 people who have Graves’ disease end up developing TED.2,4

Pretibial myxedema is a rare complication of Graves’ disease. About 5 percent of people with Graves’ disease develop pretibial myxedema.2,4

About 15 percent of people who have both Graves’ disease and TED develop pretibial myxedema. But most people who develop pretibial myxedema also have TED. This may mean that people with TED are more likely to develop pretibial myxedema. But more research is needed to confirm this link.2,4

There also may be a link between the causes of pretibial myxedema and TED. Pretibial myxedema is caused by the buildup of carbohydrates in the skin. TED is also caused by the buildup of carbohydrates. But we do not know why this buildup happens in either condition.2,4

How is it treated?

Mild cases of pretibial myxedema may improve on their own without treatment. Other cases may need treatment.3

The number of people with Graves’ disease who develop pretibial myxedema is falling. This is because Graves’ disease is becoming more commonly diagnosed. When people are able to start treatment earlier, they may reduce their risk of developing complications like pretibial myxedema.2

Often, treatment for pretibial myxedema is aimed at managing the body's immune response caused by Graves’ disease. These treatments might include:2,4

  • Antithyroid drugs
  • Beta blockers – a type of drug that can limit the effect of hormones on the body
  • Lifestyle changes such as quitting smoking, eating well, exercising, and avoiding stress
  • Surgery, in severe cases

Treatment for pretibial myxedema also often is aimed at reducing symptoms. These treatments may include:3,4

  • Cortisone creams or injections – a type of steroid that reduces inflammation
  • Compression socks or wraps on the legs
  • Avoiding injury to the skin

If you have TED and experience unexplained changes to your skin, talk to your doctor. The link between pretibial myxedema and TED is still not understood. But you do not have to live with the effects of pretibial myxedema without treatment.3,4

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