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.