THYROID ACROPACHY

By Gary M. White, MD


Thyroid acropachy is soft tissue swelling, finger clubbing and periosteal reaction of extremity bones associated with autoimmune thyroid disease. Hyperthyroidism is most typical. Thyroid dermopathy, i.e. pretibial myxedema and thyroid ophthalmopathy are often associated [J Clin Endocrinol Metab. 2002 Dec;87(12):5435-41]. Thyroid stimulating IgG antibodies are usually found. Smoking may be related.

Clinical

Clubbing of the fingers and toes associated with hyperthyroidism is characteristic. Patients are rarely hypothyroid. Periosteal proliferation of the bones of the hands and feet occurs and patients may have swelling overlying the affected bony structures. X-rays of the hands and wrists may be diagnostic but a bone scan is more sensitive.

Treatment

One clinical review found the thyroid acropachy to not usually bother the patient nor require treatment [J Clin Endocrinol Metab. 2002 Dec;87(12):5435-41]. In contrast, the ophthalmopathy may need orbital decompression and the dermopathy may need to be addressed.

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