problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl9848problendo-9848Research ArticleОбзорыReviewsПретибиальная микседема: патогенетические особенности и клинические аспектыPretibial myxedema: pathogenetic features and clinical aspectshttps://orcid.org/0000-0002-5402-9795СабановаЕкатерина АртуровнаSabanovaEkaterina A.

аспирант кафедры эндокринологии 

MD

ekaterina.sabanova@gmail.comhttps://orcid.org/0000-0002-3026-6315ФадеевВалентин ВикторовичFadeyevValentin V.

д.м.н., профессор, член-корр. РАН

MD, PhD, Professor

walfad@mail.ruhttps://orcid.org/0000-0002-9331-7714ПотекаевНиколай НиколаевичPotekaevNikolai N.

д.м.н., профессор

MD, PhD, Professor

mcdik-f2@zdrav.mos.ruhttps://orcid.org/0000-0002-3875-4030ЛьвовАндрей НиколаевичLvovAndrey N.

д.м.н., профессор

MD, PhD, Professor

alvov@mail.ru<p>ФГАОУ ВО &laquo;Первый Московский государственный медицинский университет им. И.М. Сеченова&raquo; Минздрава России (Сеченовский университет); ГБУЗ &laquo;Московский научно-практический центр дерматовенерологии и косметологии&raquo; Департамента здравоохранения Москвы</p>Россия<p>I.M. Sechenov First Moscow State Medical University (Sechenov University); Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology</p>Russian Federation<p>ФГАОУ ВО &laquo;Первый Московский государственный медицинский университет им. И.М. Сеченова&raquo; Минздрава России (Сеченовский университет)</p>Россия<p>I.M. Sechenov First Moscow State Medical University (Sechenov University)</p>Russian Federation<p>ГБУЗ &laquo;Московский научно-практический центр дерматовенерологии и косметологии&raquo; Департамента здравоохранения Москвы</p>Россия<p>Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology</p>Russian Federation201930062019652134138Copyright &#x00A9; Сабанова Е.А., Фадеев В.В., Потекаев Н.Н., Львов А.Н., 20192019Сабанова Е.А., Фадеев В.В., Потекаев Н.Н., Львов А.Н.Sabanova E.A., Fadeyev V.V., Potekaev N.N., Lvov A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/9848

Претибиальная микседема (ПМ), или тиреоидная дермопатия, – редкое экстратиреоидное проявление болезни Грейвса (БГ). Состояние сопровождается муцинозными изменениями кожи, преимущественно в области передней поверхности голени. Тяжелые формы могут приводить к лимфатическому застою и инвалидизации. Предполагается, что для манифестации ПМ необходима длительная и интенсивная аутоиммунная агрессия. Однако данные о роли антител к рецептору ТТГ в генезе ПМ весьма неоднозначны. Недавно появились указания на участие рецепторов ИФР-1 в патогенезе этого проявления БГ. В типичных случаях ПМ локализуется на передней и латеральной поверхностях обеих голеней и имеет диффузную, опухолевую, бляшковидную или слоновую форму. Ранняя диагностика сводится к регулярному профилактическому осмотру претибиальной области. Проведение диагностической биопсии показано лишь в сомнительных случаях. Поддержание эутиреоза, отказ от курения, избегание травм и ношения тесной обуви, нарушающей лимфоотток, могут снизить риск развития ПМ у пациентов с БГ. В настоящий момент отсутствуют общепринятые клинические рекомендации по диагностике и лечению тиреоидной дермопатии. В данном обзоре приведены последние сведения об этиопатогенезе ПМ и ведению пациентов с этой патологией.

Pretibial myxedema (PTM) or thyroid dermopathy is a rare extrathyroidal manifestation of Graves’ disease. The condition is accompanied by mucinous skin changes, mainly in the anterior tibial surface.

Severe forms may lead to lymphatic congestion and disability. Prolonged and intense autoimmune aggression is supposed to be necessary for PTM manifestation. However, data on the role of TSHR antibodies in the development of thyroid dermopathy are very ambiguous; evidence of IGF-1 receptor involvement in the pathogenesis was reported recently.

Typically, PTM is localized on the anterior and lateral surfaces of both tibias and can be represented by diffuse, tumorous, plaque-like, or elephantiasic forms. Currently, early diagnostics involves regular preventive examination of the pretibial area. A diagnostic biopsy is indicated only in complex cases.

Maintaining euthyroidism, smoking cessation, preventing injuries, and avoiding tight shoes that disturb lymphatic drainage are measures reducing the risk of PTM in GD patients.

Currently, there are no accepted clinical guidelines for the diagnosis and treatment of thyroid dermopathy. This review provides the recent scientific data on etiopathogenesis and management of patients with PTM.

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Commentary: rituximab, adalimumab, etanercept, tocilizumab – are biologics the future for graves’ orbitopathy? Ophthalmic Plast Reconstr Surg. 2014;30(5):420-423. doi: https://doi.org/10.1097/iop.0000000000000221

The authors declare that there are no conflicts of interest present.