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Thyroid Dermopathy and Acropachy

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Book cover Graves' Disease

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Abstract

Thyroid dermopathy that occurs in 4–13 % of patients with Graves’ ophthalmopathy is an extrathyroidal manifestation of Graves’ disease. Thyroid acropachy commonly presents with clubbing of digits and occurs in 20 % of patients with dermopathy. Basic pathogenesis of dermopathy is similar to ophthalmopathy. Presence of TSH receptor in the fibroblasts and its interaction with TSH receptor antibodies and stimulation of fibroblasts resulting in production of glycosaminoglycans is the most likely immune process. Localization of thyroid dermopathy to lower extremity is explained by mechanical factors such as dependency of the lower extremity.

Measures for prevention and treatment of dermopathy include optimal and rapid normalization of thyroid function and early local corticosteroid therapy for existing pretibial myxedema. Systemic therapies used in ophthalmopathy can be tried in refractory cases not responding to local corticosteroid therapy. In future any systemic therapy proven to be beneficial for ophthalmopathy can be used empirically for refractory cases of dermopathy.

For thyroid acropachy no specific therapy has been reported and management should be preventive and local therapy for associated dermopathy of hands and feet. In severe cases of acropachy with painful periosteal reaction, pain management will be needed.

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    Vahab Fatourechi M.D., F.R.C.P., F.A.C.E.

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    Rebecca S. Bahn

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Fatourechi, V. (2015). Thyroid Dermopathy and Acropachy. In: Bahn, R. (eds) Graves' Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2534-6_15

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