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Race for the Case

Race for the Case is a clinical quiz feature published quarterly in Dermatology World Directions in Residency — and right here!

Review the case and photos, and submit your answers to the questions below. If you answer correctly, you'll be entered to win a $25 Starbucks gift card. Free coffee and pastries are on the line — what are you waiting for?

Diagnose this case

A 42-year-old female with a distant history of Graves disease s/p radioactive iodine ablation who is now undergoing thyroid hormone replacement presented to us because of gradually enlarging lower legs over the past 6 years. She states that she had knee surgery years ago on the right knee and always had some swelling on that side but it is getting worse and the left leg is also involved now. She states that her legs are painful and a little bit stiff. Her thyroid hormone levels are now well controlled on levothyroxine. On exam, indurated plaques are noted on the lower legs and dorsal feet with non-pitting edema along with prominent exophthalmos.

  1. What is the diagnosis?
  2. What is in the differential diagnosis?
  3. What is deposited in this disease?
  4. What other manifestation of Graves is due to a deposition of this material?
  5. What is the autoantibody in Graves disease?
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