Thyroid acropachy is a medical condition, a rare condition seen in patients who are or who have been thyrotoxic. It is an extreme occurrence of autoimmune thyroid disease. Acropachy refers to the thickening of the extremities like hands and feet. It implies to following conditions:
- Digital clubbing or nail clubbing is a deformity of the fingers due to swelling of digits and toenails
- Swelling of soft tissue in hands and feet
- Periosteal that is new bone formation
It is often also associated with ophthalmopathy and thyroid dermopathy.
What Does Acropachy Mean?
Acropachy is referred to as dermopathy (a type of skin disease) associated with Graves’ disease. As mentioned above, it is characterized by soft tissue swelling of the hands and clubbing of the fingers. It is usually diagnosed through radiographic imaging of affected extremities or limbs demonstrating periostitis, most commonly of the metacarpal bones. Although the exact cause is unknown, it is observed to be caused by stimulated auto-antibodies, implicated in the pathophysiology of Graves’ thyrotoxicosis. There is no certain effective treatment for acropachy discovered yet.
Since it is closely associated with Graves’ disease, it is also associated with Graves’ ophthalmopathy and thyroid dermopathy.
Cases of Hereditary acropachy also referred to as “isolated congenital nail clubbing” may be associated with HPGD.
General findings and observation
- Thyroid acropachy is one of the least common occurrences of extra-thyroid manifestation as a result of autoimmune thyroid disease
- There has been only 0.3% of reported incidence in patients with Graves’ disease
- It may occur in hyperthyroid patients
- It commonly affects euthyroid or hypothyroid patients after the original treatment of their thyrotoxicosis
- In most cases, acropachy occurs concurrently with thyroid ophthalmopathy and dermopathy
- Chronologically, it has been observed in the sequence of extra thyroid manifestations of autoimmune thyroid disease is such that thyroid dysfunction develops first, followed by ophthalmopathy, then dermopathy, and finally causing acropachy
- The exact study for the cause of acropachy is unknown but it is assumed to be caused by the stimulation of autoantibodies to TSH and IGF-1 receptors that are implicated in the pathophysiology of Graves’ thyrotoxicosis and ophthalmopathy
- The periosteal newborn formation is a highly specific syndrome that is exhibited under thyroid acropachy on imaging and is irregular and spiculated in appearance
- These periosteal reactions tend to be asymmetrical, predominantly occurring in the hands and feet, and only rarely goes to the long bones of the forearms and lower legs
There is no specified or certain remedial treatment proven yet. Although therapy consisting of:
- Immunosuppressive drugs
- Surgery may be beneficial in case of treatment of ophthalmopathy and dermopathy
However, no effective treatment for acropachy has been established yet.
Medically, thyroid acropachy is a relatively benign condition as it is often asymptomatic. The importance of deriving its accurate diagnosis is to determine whether the presence of clubbing and swelling of the extremities is not a result of pulmonary, cardiac, or hepatic disease. It is important to note here, that swelling, or clubbing need not necessarily be indicative of the latter mentioned diseases.
An Abstract from The Journal of Clinical Endocrinology & Metabolism
Thyroid acropachy is an extreme manifestation of autoimmune thyroid disease. It presents with digital clubbing, swelling of digits and toes, and the periosteal reaction of extremity bones. It is almost always associated with ophthalmopathy and thyroid dermopathy. During a 26-yr period at our institution, of 178 patients with thyroid dermopathy, 40 had acropachy. Clubbing associated with thyroid dermopathy (pretibial myxedema) was seen in 35 patients. Clubbing usually was not a patient complaint and was noted only by clinical observers. Four of eight patients with hand and extremity radiographs had periosteal reaction. Seven had associated extremity and joint pain; this pain was absent at long-term follow-up. Half of the patients required systemic corticosteroid therapy, 53% required transantral or transfrontal orbital decompression for severe ophthalmopathy, and 18% had the elephantiasic form of dermopathy. Cigarette-smoking rates were 81% for women and 75% for men (mean, 28 pack-years). All 13 patients who had thyroid-stimulating Ig measurements had high titers. Long-term follow-up (median, 12.5 yr) revealed that acropachy was not a complaint in follow-up visits or questionnaires. The data suggest that thyroid acropachy is an indicator of severity of ophthalmopathy and dermopathy. It is a source of clinical concern only if dermopathy is persistent and severe.
Ophthalmopathy, dermopathy, and acropachy are all extrathyroidal manifestations of autoimmune thyroid disease. Ophthalmopathy is therefore, almost always present with dermopathy. Acropachy is in extreme cases of dermopathy present with clubbing and swelling of fingers and toes, with or without periosteal formation of distal bones. Rarely, acropachy may occur along with the occurrence of distal joints. Many isolated reports of acropachy have appeared in the medical literature, but there are no thorough studies or results to follow.
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