title: Hypothyroid Graves' disease complicated with elephantiasis nostras verrucosa (ENV): a case report and review of the literature.
abstract: Thyroid dermopathy is not a frequent feature of hyperthyroid Graves' disease, being present in less than 5% of the patients. Graves' disease has been shown to exist in euthyroid or hypothyroid forms in untreated patients. Here, we describe a case of hypothyroid Graves' disease with elephantiasis nostras verrucosa (ENV), which is an extreme form of thyroid dermopathy (TD). A 58-year-old female patient was admitted to the emergency department with somnolence, hypothermia, and bradycardia. Her mental status gradually worsened, resulting in a deep coma. She was intubated and followed in the intensive care unit, as she needed mechanical ventilatory assistance due to respiratory failure. She also had bilateral non-pitting edema, a cobblestone-like appearance, and hyperkeratotic greenish-brown-colored lesions in the pretibial and dorsal regions of the feet that were compatible with ENV. Hypothyroid Graves' disease is a very rare condition among autoimmune thyroid disorders, and ENV is an extremely rare form of TD. Here, we present a patient with hypothyroid Graves' disease and ENV.
authors.affiliation: Endocrinology and Metabolism Department, Hacettepe University, 06100, Ankara, Turkey. kukinc@comu.edu.tr
authors.forename: Kubilay
authors.initials: K
authors.lastname: Ukinç
authors.forename: Miyase
authors.initials: M
authors.lastname: Bayraktar
authors.forename: Arzu
authors.initials: A
authors.lastname: Gedik
mesh_terms: D004604:Elephantiasis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000628:therapy; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000628:therapy; D007868:Leg Dermatoses / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged