Thyroid acropachy: correlation of imaging and pathology

Abstract

A 65-year-old woman presented with progressive swelling of the anterior aspect of both legs, the dorsal aspect of the feet (Fig. 1a), and the fingers, together with clubbing of the last (Fig. 1b). These features had been present for 4 years but she had only recently developed discomfort and pain in her feet from pinching shoes. The overlying skin was indurated with red-purple discoloration. A localized nodular thickening sharply demarcated from the surrounding skin surface was seen on the dorsal aspect of both feet (Fig. 1a).The patient's past medical history was unremarkable except for hyperthyroidism of Graves, which she had had for 10 years and for which she had received treatment with iodine-131 on three occasions. The last dose of iodine-131 was administered a year before the present hospital presentation. She was currently euthyroid taking thyroxine replacement therapy.On physical examination the thyroid gland was normal. Marked exophthalmos had been present from the onset of Graves' disease but did not required surgical therapy. On CT scan of the orbit, marked proptosis was confirmed (Fig. 2a), as well as thickening of the extraocular muscles (Fig. 2b).Laboratory examination of the thyroid function revealed a suppressed thyroid-stimulating hormone level and an elevated titer of thyroid stimulating immunoglobulin.Radiographs of the hands revealed a bilateral feathery diaphyseal periosteal reaction on the radial side of the first and second Eur.Abstract Thyroid acropachy is a rare manifestation of autoimmune thyroid disease, in the form of soft tissue swelling of the hands and feet with insidious onset, associated with clubbing and characteristic periosteal reactions. It is usually part of a syndrome consisting of a typical triad of thyroid acropachy, exophthalmos, and pretibial myxedema. The purpose of this case report is to demonstrate the imaging features of this typical triad in a 65-year-oldwoman. This case is the first in which the MRI features of thyroid dermopathy are documented.

Investigation of the Presence of Acropachy in Patients With Autoimmune Thyroid Diseases

“…The common antigen may be TSH-R. 3 Histologically, the principal abnormality in pretibial myxedema is the marked increase in glycosaminoglycan (GAG) concentration, especially hyaluronic acid, in the skin. GAGs are the major components of proteoglycans, very large polyanions that bind water and cations and form the extracellular medium or the ground substance of connective tissue.…”

“…GAGs are the major components of proteoglycans, very large polyanions that bind water and cations and form the extracellular medium or the ground substance of connective tissue. 3 To demonstrate the increased presence of hyaluronic acid in a routinely fixed, paraffin-embedded skin biopsy, alcian blue staining is performed. 3,5 Clinical findings of thyroid acropachy include an insidious, usually painless, onset of finger clubbing and fusiform soft-tissue swelling.…”

“…Serum levels of FT 4 , FT 3 , and TSH were measured on an automated immunoassay analyzer, the ACS-180 Plus (Chiron Corp., Halstead, UK). The FT 4 and FT 3 were measured with a competitive labeled antibody assay using an acridinium ester as label and paramagnetic particles as solid phase.…”

“…It is usually associated with Graves disease, but has been described in Hashimoto thyroiditis. [1][2][3] Thyroid dermopathy and acropachy occur in 4% and 1%, respectively, of patients with opthalmopathy. Seven percent of patients with pretibial myxedema have thyroid acropachy.…”

Regressão do hipocratismo digital em pacientes com câncer de pulmão tratados cirurgicamente

“…It can also be related to chronic liver diseases, (4) bowel diseases, (5) and thyroid diseases, (6) or it can be hereditary. (7) It can occur in isolation or as a result of hypertrophic osteoarthropathy (HOA, or Marie-Bamberger syndrome), which can also produce prominent skin manifestations.…”