对称性疤痕疙瘩样胫前黏液性水肿的临床诊断学特征

Diagnostic features of symmetric keloid-like pretibial myxedema

目的探讨甲状腺功能亢进症^(131)I治疗后,甲状腺功能减退性胫前黏液性水肿的临床诊断学特征。方法回顾性分析2017年10月16日,佛山市中医院普外科收治的1例临床表现为对称性疤痕疙瘩样胫前黏液性水肿患者的临床资料。结果患者8年前因"甲状腺功能亢进症"经^(131)I治疗,治疗6个月后双侧小腿出现指尖样突起的肿物。2017年10月16日入院时双侧胫前均见约80 mm×40 mm皮下肿物,皮肤呈疤痕疙瘩样改变。甲状腺功能示游离三碘甲状腺原氨酸<2.12 pmol/L,游离甲状腺素<4.12 pmol/L,促甲状腺素88.56 mU/L,抗甲状腺过氧化物酶抗体27.45 IU/ml,抗甲状腺球蛋白抗体<10.00 IU/ml,促甲状腺素受体抗体15.31 IU/L,甲状腺球蛋白9.89μg/L;甲状腺彩超示甲状腺萎缩并血供减少;下肢肿物超声示双侧小腿中下段胫前部囊性肿块(性质待定),行双侧胫前肿物切除术,术后病理示:皮肤组织,真皮大量粘蛋白沉积,形态学符合胫前黏液水肿。结论了解胫前黏液性水肿的临床特征及特异性表现,可提高相关疾病诊断准确率,有利于指导临床治疗。

Objective To investigate the clinical diagnostic characteristics of hypothyroidism pretibial myxedema(PM)after 131 I treatment.Methods One case with clinical manifestations of symmetrical keloid-like PM was retrospectively analyzed.Results The patient was treated by 131 I for“hyperthyroidism”eight years ago,half a year after the treatment,the patient′s bilateral calves showed finger-like protrusions.On October 16,2017,subcutaneous masses were seen on the bilateral anterior tibiae with size of 80 mm×40 mm,and the skin showed keloid-like changes.Thyroid function showed free triiodothyronine(FT3)<2.12 pmol/L,free thyroxine(FT4)<4.12 pmol/L,thyrotropin(TSH)88.56 mU/L,anti-thyroid peroxidase antibody(TPOAb)27.45 IU/ml,anti-thyroglobulin antibody(TgAb)<10.00 IU/ml,thyrotropin receptor antibody(TRAb)15.31 IU/L and thyroglobulin(Tg)9.89μg/L.Thyroid color ultrasound showed thyroid atrophy with decreased blood supply.Postoperative pathology showed:skin tissue,a large number of dermal mucins deposition,morphology were consistent with anterior tibial mucoid edema.Conclusion The understanding of the clinical features and specific manifestations of anterior tibial myxedema can improve the diagnostic accuracy and guide clinical treatment.