EXOPHTHALMOS AND LOCALIZED PRETIBIAL MYXEDEMA IN A EUTHYROID PATIENT: STUDIES WITH TRIIODOTHYRONINE*

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Abstract
RARELY, patients exhibit eye signs of Graves' disease without evidence of thyroidal overactivity. These cases may represent a variant of Graves' disease with eye signs manifest prior to hyperthyroidism. Occasionally, however, hyperthyroidism does not develop. A series of such patients has recently been studied by Werner (1), who found that they exhibited the abnormal response to administration of triiodothyronine and thyrotropin characteristic of patients with active thyrotoxicosis, in spite of the fact that by ordinary clinical and laboratory criteria they were euthyroid at the time of study. Localized pretibial myxedema, also a relatively rare sign, characteristically appears during active hyperthyroidism or after treatment has been initiated (2). To my knowledge, its occurrence without antecedent hyperthyroidism has been reported only once (3). The present patient had both marked exophthalmos and localized myxedema without hyperthyroidism. In studies of the effect of triiodothyronine on the thyroidal secretion rate, there was an abnormal response.The concentration of labelled triiodothyronine in the skin of the localized myxedematous area was found to be the same as the concentration in the patient's normal skin.

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