title: Radiation therapy as part of the therapeutic regimen for extensive multilocular myxedema in a patient with exophthalmos, myxedema and osteoarthropathy syndrome: A case report.
abstract: Exophthalmos, myxedema and osteoarthropathy (EMO) comprise the triad known as EMO syndrome, which is rarely observed in patients with autoimmune thyroid disease. The present study reports the case of a patient with EMO, including the response of this rare combination to radiotherapy. A 48-year-old patient with EMO syndrome presented to the Department of Radiation Oncology, University Hospital of Muenster, eight years prior to writing with therapy-resistant pretibial myxedema and hypertrophic osteoarthropathy of the metacarpal bones. The patient had been diagnosed with Graves' disease (GD) 26 years prior to presentation, which was treated by thyroidectomy and radioiodine therapy. Four years subsequent to the diagnosis of GD, the patient developed exophthalmos, which was treated using radiotherapy. An evident pretibial, foot and hand myxedema developed within the 10 years following the onset of orbitopathy. The skin lesions were treated using radiation therapy subsequent to the failure of multiple surgical procedures and medical treatments. Almost eight years subsequent to the administration of irradiation, no recurrence was observed on the lower right leg, nor was any recurrence on the lower left leg observed approximately four years subsequent to the completion of radiotherapy. However, an additional lesion on the left hand demonstrated slow progression following treatment with radiation therapy. The present study indicates that radiation therapy can be considered as adjuvant therapy for patients with refractory myxedema, to prevent or delay the recurrence of myxedema subsequent to surgical excision.
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany.
authors.forename: Khaled
authors.initials: K
authors.lastname: Elsayad
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Kriz
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Bauch
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany.
authors.forename: Sergiu
authors.initials: S
authors.lastname: Scobioala
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Haverkamp
authors.affiliation: Department of Dermatology, University Hospital of Muenster, Muenster D-48149, Germany.
authors.forename: Cord
authors.initials: C
authors.lastname: Sunderkötter
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster D-48149, Germany.
authors.forename: Hans Theodor
authors.initials: HT
authors.lastname: Eich
keywords: EMO syndrome; Graves' disease; exophthalmos; myxedema; osteoarthropathy; radiotherapy