Secondary HOA is associated with underlying cardiopulmonary diseases and malignancies, thyroid acropachy
, acromegaly, and chronic inflammatory rheumatic diseases.
One patient (case 3) had impaired T-cell function with weight loss, hepatosplenomegaly, acropachy
, and rash.
Pretibial myxedema, acropachy
, alopecia, onycholysis and sometimes paralysis
Hyperthyroidism with periodic paralysis, acropachy
, pre-tibial myxoedema, transient atrial fibrillation and myopathy.
In the literature we rarely see thyroid acropachy
cases with thinkenings on acral regions, normal radiography concurently; or cases without other symptoms and signs of Graves' disease.
They cover signs and symptoms; the genetic, immune system, and environmental aspects of pathology in hyperthyroid disorders; coexisting conditions like nodular disease and vitamin B12 deficiency; conventional treatments; alternative and complementary therapies; hyperthyroidism in pregnancy, the postpartum period, and children and adolescents; and Graves' ophthalmopathy and other extrathyroidal manifestations, such as euthyroid Graves' disease, pretibial myxedema, and thyroid acropachy
8 Thyroid acropachy
noted in (less then) 1 in 1000 patients9 and other autoimmune events such as vitiligo, premature graying of hair and urticaria may be present.
TABLE 1 Clinical manifestations of hyperthyroidism (2) Acropachy
(swelling of the fingers) Bruit (thyroid) Decreased attention span Diarrhea Edema Exertional dyspnea Fatigue Goiter (smooth or nodular) Gynecomastia Hair loss Heat intolerance Hyperactive deep tendon reflex Hypertension Increased appetite Infertility Insomnia Lid lag, proptosis Muscle weakness Nervousness and irritability Oligomenorrhea Palmar erythema Palpitations Paralysis (sudden) Photophobia, eye irritation, diplopia Pretibial myxedema Tachycardia Tremors Warm, moist skin Weight loss TABLE 2 Clinical and laboratory findings associated with common causes of hyperthyroidism (51-57) Mechanism Thyroid exam Lab results Graves' Antithyroid Diffuse goiter Low TSH; disease antibodies elevated [T.
The differential diagnosis includes secondary HOA, acromegaly, thyroid acropachy
and syphilitic periostitis.
Pretibial myxoedema is a known manifestation of Graves' disease that occurs in association with diffuse thyroid gland enlargement, exophthalmos, and thyroid acropachy
Hyperthyroidism causes pretibial myxedema (thickened waxy plaques occurring in up to 10% of patients and almost always with accompanying ophthalmopathy), palmar erythema, soft thickened skin, increased sweating of the hands and feet, and thyroid acropachy
(clubbing of fingers or toes) in Grave's disease.
It typically presents with enlargement of the thyroid gland (goiter), signs and symptoms of excessive thyroid function, ophthalmopathy (which is severe in 3% to 5% of cases), and less frequently pretibial myxedema and acropachy