ArticleThyroid research2025
Effective treatment of pretibial myxoedema with tofacitinib: a case report and analysis of immunopathogenesis.
Article in Thyroid research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPretibial myxoedema (PTM), a rare extrathyroidal manifestation of Graves' disease (GD), is characterized by dermal glycosaminoglycans (GAGs) deposition. Current therapies (e.g., glucocorticoids) show limited efficacy with high relapse rates. Emerging evidence implicates JAK-STAT pathway activation via thyrotropin receptor antibodies (TRAb) in the pathogenesis of PTM, suggesting JAK inhibitors, such as Tofacitinib, as potential therapy. CASE PRESENTATION: A 39-year-old man with GD and Graves' orbitopathy (GO) presented with bilateral pretibial non-pitting edema and itchy erythematous nodules. Histopathology from skin biopsy confirmed GAGs deposition and elevated TRAb (> 40 IU/L). After transient response to intralesional glucocorticoids, oral tofacitinib (5 mg twice daily) was initiated. Significant resolution of edema (body surface area: 12%→3%) and GO occurred within 1 month, sustained over 6 months without adverse events.
conclusionTofacitinib demonstrated rapid and durable efficacy in refractory PTM, likely by suppressing JAK-STAT-mediated fibroblast activation and pro-inflammatory cytokine release. This supports its role as a potential targeted oral therapy for PTM.
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