Pretibial Myxedema, Nodular Variant: Unique Presentation and Clinical Course

Literature has shown morphological diversity in the presentation and occurrence of pretibial myxedema following I-131 treatment. We present a case of a 47 y.o African American male with post I-131 hypothyroidism for Graves disease that presented with enlarging bilateral lower extremity and ankle lesions. Examination revealed firm, tender, hemispherical, large, hyperpigmented nodules. Ultrasound demonstrated nonspecific hypovascular nodular thickening of the skin. Excisional biopsy showed reactive dermal and subcutaneous fibrosis with dermal mucinosis. Alcian blue stain confirmed the diagnosis. Graves’ dermopathy is generally rare, with the nodular variant accounting for 10% of cases. Our case reflects a variable appearance of post-I-131 treatment dermopathy partially resistant to the multimodal treatment.