From the Guidelines
Hyperpigmentation in Graves' Disease
Hyperpigmentation is a feature of Graves' disease that is more prevalent in Blacks than in Whites.
- This increased prevalence is attributed to the heightened sensitivity of melanocytes to the melanin-stimulating effects of excess thyroid hormones in darker-skinned individuals 1.
- The hyperpigmentation can manifest as diffuse or localized darkening of the skin, particularly in sun-exposed areas.
- Management of hyperpigmentation in Black patients with Graves' disease may involve closer monitoring and medications such as methimazole or propylthiouracil to control thyroid hormone levels and alleviate symptoms.
- It is essential to recognize and manage hyperpigmentation early, as it can significantly impact the patient's quality of life, and dose de-escalation may be necessary to maintain responses while preserving quality of life, as seen with talquetamab-related toxicities 1.
From the Research
Features of Graves' Disease in Blacks vs Whites
- Hyperpigmentation is more prevalent in Black patients with Graves' disease compared to non-Black patients, with an incidence of 38% in Black patients and 0% in non-Black patients 2
- Serum thyroxine levels were found to be higher in Black patients with Graves' disease compared to non-Black patients, which may contribute to the increased incidence of hyperpigmentation 2
- The exact mechanisms of hyperpigmentation in Graves' disease are not fully understood, but it is proposed that elevated adrenocorticotropic hormone (ACTH) and anti-TSH receptor stimulating antibody may play a role 3
Comparison of Hyperpigmentation in Graves' Disease
- A study found that 12 out of 14 Black patients with Graves' disease presented with hyperpigmentation, whereas none of the 18 non-Black patients presented with this symptom 2
- The study suggests that hyperpigmentation is a common feature of Graves' disease in Black patients, but further research is needed to understand the underlying mechanisms and to determine the prevalence of hyperpigmentation in other populations 2
Treatment and Management of Graves' Disease
- The treatment of Graves' disease typically involves antithyroid drugs, radioactive iodine, or surgery, and the choice of treatment depends on the individual patient's needs and circumstances 4
- Hyperpigmentation associated with Graves' disease may improve with treatment of the underlying condition, as seen in a case report where a patient's hyperpigmentation abated after treatment with methimazole and beta blockers 3