Thyroid acropachy

Last revised by Maria Khan on 5 Dec 2022

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

The majority of patients are smokers.

Clinically, it presents with soft tissue swelling, finger clubbing, and periosteal reaction of the extremities.

  • 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

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Cases and figures

  • Case 1
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