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Thyroid Acropachy

General Considerations

  • One of the extra-thyroidal manifestations of autoimmune thyroid disease
  • Occurs in about 1% of patients with Grave’s Disease
  • Almost always associated with ophthalmopathy
  • May be associated with thyroid dermopathy (myxedema)
  • Chronology of findings is usually thyroid dysfunction, ophthalmopathy, dermopathy and then acropachy
  • Most patients are also smokers
  • Can occur in both euthyroid and hypothyroid patients and usually follows the manifestations of thyroid dysfunction itself
    • May occur after radioactive treatment for hyperthyroidism

Clinical Findings

  • Asymptomatic in most patients
  • Clubbing
  • Swelling of the fingers and toes
  • Joint pain, especially small joints
  • High thyroid stimulating antibody titers

Imaging Findings

  • Clubbing of the fingernails and toenails
  • Swelling of the fingers and toes
  • Solid periosteal new bone formation
    • May be thin or thick
    • Sometimes spiculated or lacy in appearance
    • Involves the metacarpals, proximal and middle phalanges of the hand, metatarsals and proximal phalanges of the toes
  • Usually bilateral and symmetric, but may be asymmetric, sometimes involving a single digit
  • Radionuclide bone scans may show radiotracer uptake before findings visible on conventional radiographs

Differential Diagnosis

  • Hypertrophic osteoarthropathy
    • Usually involves long bones, but spares the ends
    • Symmetric
  • Pachydermoperiostitis
    • Idiopathic variety of hypertrophic osteoarthropathy
    • Younger
    • Involves forearm, tibia and fibula
    • Does not spare the ends of bones
  • Hypervitaminosis A
    • Generalized periostitis


  • Immunosuppressive therapy and steroid administration for thyrotoxicosis


  • Remission of findings may occur in long-term

thyroid acropachy

Thyroid Acropachy. Thick, wavy periosteal reaction is seen along the shafts
of the 1st through 4th metatarsals bilaterally (white circles).

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For more information, click on the link if you see this icon

Thyroid Acropachy: Report of 40 Patients Treated at a Single Institution in a 26-Year Period. V Fatourechi, DDF Ahmed, and KM Schwartz. The Journal of Clinical Endocrinology & Metabolism 87(12):5435–5441 

Thyroid Acropachy. O Batal and SF. Hatem. Orthopedics January 2008;31(1):2.