Thyroid Acropachy: A Rare Manifestation of Graves Disease in Joints

Abstract

Objective:The objective of this report was to describe a patient with Graves acropachy, a rare manifestation of Graves disease (GD) that is clinically defined by skin tightness, digital clubbing, small-joint pain, and soft tissue edema progressing over months or years with gradual curving and enlargement of the fingers.Methods: The patient was evaluated regarding thyroid function (serum free T4 [FT4] and thyroid-stimulating hormone [TSH] quantifications) and autoimmunity biomarkers (thyroid receptor antibody [TRAb]) as well as radiographic investigation of the extremities.Results: A 52-year-old man presented with a history of thyrotoxicosis and clinical signs of Graves orbitopathy. Laboratory tests showed suppressed TSH (0.01 UI/L; normal, 0.4 to 4.5 UI/L) and elevated serum FT4 (7.77 ng/ dL; normal, 0.93 to 1.7 ng/dL), with high TRAb levels (40 UI/L; normal, <1.75 UI/L). A diagnosis of thyrotoxicosis due to GD was made and the patient was treated with methimazole. After the patient complained of swelling in hands and feet, X-ray evaluation was conducted and established the thyroid acropachy. Conclusion:We present a case of a patient with GD associated with worsening extrathyroid manifestations during orbitopathy, dermopathy, and developed acropachy in hands and feet. (AACE Clinical Case Rep. 2019;5:e369-e371) Abbreviations: FT4 = free T4; GD = Graves disease; GO = Graves orbitopathy; TRAb = thyroid receptor antibodies; TSH = thyroid-stimulating hormone

A Complete Form of Pachydermoperiostosis Accompanied by a Pituitary Microadenoma

“… 10 , 19 In this case, the patient was diagnosed with PDP due to facial disfigurement, digital clubbing and the periostosis of the long bones, although a pituitary microadenoma was found.…”

“…17,18 Radiological study reveals periosteal reactions predominantly in metacarpals and phalanges of the fingers, and rarely in long bones. 10,19 In this case, the patient was diagnosed with PDP due to facial disfigurement, digital clubbing and the periostosis of the long bones, although a pituitary microadenoma was found.…”

Severe nail pain as the presenting symptom of thyroid acropachy

“…1,6 Histology of surrounding skin demonstrates nodular fibrosis in the distal periosteum. 3 Besides management of pain and thyroid disease, there are no targeted treatments for thyroid acropachy. Oftentimes, local or systemic corticosteroid treatment simultaneously directed at dermopathy or ophthalmopathy also alleviates acropachy symptoms of small joint pain.…”

“…1 The pathogenesis of acropachy is likely similar to that of thyroid dermopathy, with autoimmune and inflammatory responses resulting in increased glycosaminoglycan and fibroblast proliferation in the periosteum. 3 Acropachy is thus almost always seen concurrently with thyroid ophthalmopathy and dermopathy, often chronologically presenting last of the three. 4 There is also a strong association with tobacco use.…”

Clinical Imaging Features of Thyroid Acropachy

“…Thyroid acropachy is a rare manifestation of autoimmune thyroid disease presenting clinical symptoms of skin tightness, digital clubbing, small-joint pain, and soft tissue edema ( 1 , 2 ). Generally, thyroid acropachy and dermopathy occur with thyroid ophthalmopathy and are considered markers of severe ophthalmopathy ( 3 ).…”