CASE REPORT
In May 2020, a 27 year old man reported an history of persistently high
TSH-R-Abs and persistent hyperthyroidism, after more than 24 months of
therapy with methimazole. Laboratory studies showed a thyrotropin level
of 0,009 μU per milliliter (reference range, 0.40 to 3.80), a free
triiodothyronine level of 9.93 ng per deciliter (reference range, 0.26
to 0.44), and a free thyroxine level of 2.33 ng per deciliter (reference
range, 0.9 to 1.6). He had been referred to surgeon for total
thyroidectomy. In May 2021 he was still waiting for surgical procedure
to be performed and he returned to the endocrinologist complaining of
palpitations and trembling. He was on methimazole treatment, and the
laboratory findings evidenced a thyrotropin level of 0,009 μU per
milliliter (reference range, 0.40 to 3.80), a free triiodothyronine
level of 15.9 ng per deciliter (reference range, 0.26 to 0.44), and a
free thyroxine level of 3.41 ng per deciliter (reference range, 0.9 to
1.6) and elevated levels of thyrotropin-receptor antibodies (118 IU per
liter [reference value, <1.0]). On examination, he had
lesions symmetrical in the lower extremity with an appearance similar to
orange skin, with nonpitting edema on the pretibial region of the right
and left legs (Fig 1, Panel A and B respectively) with soft tissue
swelling leading to diagnosis of thyroid dermopathy. No signs and
symptoms of GO. He had consulted a dermatologist who had recommended him
an oral prednisone treatment in scalar doses which he had practiced for
15 days, blaming methimazole assumption.