Elephantiasic pretibial myxedema, chronic and recalcitrant thyroid dermopathy

Patients afflicted with autoimmune thyroiditis, specifically Graves disease, can have extrathyroidal manifestations such as exophthalmos, thyroid dermopathy, and acropachy. Thyroid dermopathy usually presents as pretibial myxedema (PTM) due to its predilection for the pretibial area. In severe forms of PTM, it can present as the elephantiasic form, which is notoriously resistant to conventional treatment. Due to the disease rarity, only a few case reports of elephantiasic PTM exist in the literature.