Morphological Diversity of Pretibial Myxedema and Its Mechanism of Evolving Process and Outcome: A Retrospective Study of 216 Cases

Figure 14

The fluctuation of serum TRAb levels with the extension of course. (a) Means of serum TRAb titers fluctuated with the extension of course in 216 PTM cases. The serum TRAb titers were  IU/L () between 20 days and 3 months of course,  IU/L () between 4 and 6 months,  IU/L () between 7 and 12 months,  IU/L () between 13 and 24 months,  IU/L () between 25 and 60 months,  IU/L () between 61 and 120 months, and  IU/L () between 121 and 192 months. By multiple comparisons with Post Hoc Tests, the serum TRAb titers between 0.67 and 3 months were statistically higher than those between 7 and 12 months () and those between 25 and 60 months (), respectively. Mean difference and 95% confidence intervals were 84.48 19.74, 149.22 and 81.2 5.71, 156.69, respectively. There were no significant differences among 0.67–3, 4–6, 13–24, 61–120, and 121–192 months of PTM course (). The data demonstrated that the serum TRAb levels fluctuated in the 16-year course. (b) In 185 cases at active stage, means of serum TRAb titers fluctuated with the extension of a 192-month course. (c) In a PTM case with repeats of remission and relapse in about 2 years after a 14-year history, serum TRAb titers fluctuated between 252 IU/L and 840 IU/L. Even though his course was more than 14 years and steroid therapy, there were no trends of autoimmunity activity to stop and of PTM lesions to subside spontaneously. (d) In a patient with 5 repeats of recurrence and remission from November 5, 2012, to December 19, 2013, serum TRAb titers increased when lesion recurred and decreased when lesions subsided after therapy.

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