Pretibial myxedema and high-dose intravenous immunoglobulin treatment

• Published in: Thyroid (New York, N.Y.) Vol. 4; no. 4; p. 399
• Main Authors: Antonelli, A, Navarranne, A, Palla, R, Alberti, B, Saracino, A, Mestre, C, Roger, P, Agostini, S, Baschieri, L
• Format: Journal Article
• Language: English
• Published: United States 1994
• Subjects: Adult; Aged; Autoantibodies - blood; Biopsy; Female; Graves Disease - drug therapy; Graves Disease - pathology; Graves Disease - physiopathology; Humans; Immunoglobulins, Intravenous - administration & dosage; Injections, Intravenous; Leg Dermatoses - drug therapy; Leg Dermatoses - pathology; Leg Dermatoses - physiopathology; Male; Middle Aged; Myxedema - drug therapy; Myxedema - pathology; Myxedema - physiopathology; Retrospective Studies; Thyroid Gland - drug effects; Thyroid Gland - immunology; Thyroid Gland - physiopathology
• ISSN: 1050-7256
• DOI: 10.1089/thy.1994.4.399

Seven patients affected by Graves' ophthalmopathy and pretibial myxedema (four patients with nodular form, two with diffuse, and one with elephanthiasic form) have been treated with high-dose intravenous immunoglobulins. We have observed (a) clinical improvement of pretibial myxedema and Graves' ophthalmopathy in all patients, (b) a reduction of pretibial skin thickness, by ultrasonography evaluation, in four patients, (c) a reduction of mucopolysaccharide skin content in three patients, (d) disappearance of lymphocytic skin infiltration and IgG deposition in two patients, and (e) a parallel reduction of the titer of circulating autoantibodies as antithyroglobulin, antimicrosomal, anti-TSH receptor, and of non-organ-specific antibodies as antinuclear, anti-smooth muscle cells, and anti-mitochondrial. In comparison two patients with Graves' ophthalmopathy and pretibial myxedema treated with systemic corticosteroids did not present any improvement of the cutaneous ailment. Therefore, this study suggests that intravenous immunoglobulins are effective in the treatment of pretibial myxedema and may have an immunomodulant action in patients with Graves' disease and related disorders.