Graves disease with atypical localization of dermopathy and thyroid eye disease

<p><strong>Background</strong>: Graves disease is an autoimmune condition. Simultaneous occurrence of Graves dermopathy and thyroid eye disease is a rare extrathyroidal manifestation. Here we present such a case and its improvement during the treatment.</p> <p><strong>Case Presentation</strong>: A 47-year-old woman with skin rash, pruritus, extremity swelling, tachycardia, proptosis with worsening vision, was previously examined by a dermatologist and was referred to an endocrinologist. She reported lesions on the lower and upper extremities. Laboratory findings revealed the following: suppressed thyroid-stimulating hormone, elevated free thyroxine, elevated anti- thyroid peroxidase, markedly elevated thyrotropin receptor antibodies of &gt;40 IU/L (n&le;1.75 IU/L). Skin biopsy demonstrated histopathological findings consistent with thyroid dermopathy. As a result of examination, she was diagnosed with Graves disease and was administered methimazole, pantoprazole, propranolol, prednisolone. Smoking cessation was advised. 1 month after starting treatment, her symptoms had decreased. Among these, the swelling and lesions over the extremities resolved. Only exophthalmos persisted.</p> <p><strong>Conclusion</strong>:&nbsp;The report describes a rare presentation of Graves disease. Because of the atypical morphology and involvement of the forearms, skin biopsy was important in supporting the diagnosis and excluding alternative inflammatory or infiltrative dermatoses</p>