Thyroid acropachy is an unusual presentation of autoimmune thyroid disease (~1% of patients with Graves disease). It can occur in hyperthyroid, euthyroid, hypothyroid, or even post-treatment patients. It is almost always associated with thyroid ophthalmopathy.
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Epidemiology
The majority of patients are smokers.
Clinical presentation
Clinically, it presents with soft tissue swelling, finger clubbing, and periosteal reaction of the extremities.
Radiographic features
Plain radiograph
hands and feet involvement
tubular bones
usually bilateral and symmetrical
prominent smooth flowing periosteal reaction with new bone formation at the metacarpals and phalanges
soft tissue swelling (especially lower limbs) may be present
Differential diagnosis
voriconazole induced periostitis
From a practical standpoint, thyroid acropachy always affects the ulnar side of the fifth metacarpal. This is a helpful distinguishing factor that can be used to differentiate thyroid acropachy from other conditions causing diffuse periostitis, such as hypertrophic pulmonary osteoarthropathy and pachydermoperiostosis 7.
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