A case report of a man in his 50s with elephantiasic pretibial myxedema (PTM) presenting with 6 years of bilateral lower-extremity swelling and 4 years of nodular hyperplasia, in the setting of Graves disease treated with radioactive iodine therapy leading to iatrogenic hypothyroidism.
The patient had elevated thyrotropin and thyrotropin receptor antibodies confirming hypothyroidism; vascular studies showed bilateral superficial varicose veins, partial left-sided thrombosis, and thoracic duct outlet obstruction. Despite thoracic ductoplasty and dilatation, nodularity continued to progress.
Single case report with no comparator or treatment outcome data beyond noting continued progression after surgical intervention; full text was not available, limiting detail on diagnostic workup and management.
In patients with Graves disease who develop progressive lower-leg swelling and nodular skin changes — especially after radioactive iodine therapy — consider elephantiasic pretibial myxedema and check thyrotropin receptor antibodies. Thoracic ductoplasty may not halt disease progression in this rare variant.
