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Systemic Diseases and the Skin
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Jana Kazandjieva, Razvigor Darlenski, Nikolai Tsankov
Thyroid acropachy is most often occurring in patients with a long history of active hyperthyroidism disease. Thyroid acropachy is a triad consisting of digital clubbing, soft tissue swelling of the hands and feet, and periosteal new bone formation with possible pain in the digits. Thyroid acropachy is an indicator of severity of dermopathy and ophthalmopathy.
Thyroid disease
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Graves’ ophthalmopathy can be disfiguring and can threaten sight. It becomes clinically apparent in approximately one-third of Graves’ patients. Its clinical course typically comprises an active phase lasting for up to 3 years involving increased tearing and ocular discomfort and proptosis, which may occasionally cause diplopia and even loss of vision. An inactive phase follows during which eye symptoms stabilise. More rarely, occurring in 1%–4% of Graves’ patients, thyroid dermopathy involving characteristically non-pitting pretibial swelling is evident. In some with dermopathy, acropachy, which resembles finger clubbing, is also evident.
The diagnostic evaluation and management of hyperthyroidism due to Graves’ disease, toxic nodules, and toxic multinodular goiter
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Pretibial myxedema results from excessive lymphocyte infiltration in the pretibial area, with resultant mucopolysaccharide deposition by fibroblasts (33, 34). The clinical result may simply be a small area of raised discoloration in the pretibial area. Rarely, a large area of induration and nonpitting edema may develop, sometimes involving the entire lower leg. In this circumstance, the patient may have difficulty wearing shoes and the area may be pruritic and even painful (Figure 2.5). Although the cause of pretibial myxedema is unknown, it seems to be related to anti-TSH receptor antibody levels (63). Pretibial myxedema usually does not occur unless a patient has clinical evidence of ophthalmopathy, and pretibial myxedema may occur in other anatomic sites, such as the feet, face, or preradial area. Topical steroids, usually recommended to be used under an occlusive dressing, is the most effective therapy, but the response is poor in patients with more severe disease. Thyroid acropachy, which is clubbing of the fingers and toes, occurs rarely in Graves’ disease and develops almost exclusively in patients with concomitant ophthalmopathy and dermopathy (Figure 2.6). The etiology is unknown (32).
Recognizing skin conditions in patients with cirrhosis: a narrative review
Published in Annals of Medicine, 2022
Ying Liu, Yunyu Zhao, Xu Gao, Jiashu Liu, Fanpu Ji, Yao-Chun Hsu, Zhengxiao Li, Mindie H. Nguyen
Clubbing (Figure 2(g)) is the incrassation of the soft organization beneath the proximal nail plate, leading to increased curvature of the nails. Diagnostic findings include Lovibond’s angle, and the Schamroth sign [44]. This condition may indicate cyanotic congenital heart disease, pulmonary fibrosis, bronchial carcinoma, inflammatory bowel disease, cirrhosis and thyroid acropachy. Although the underlying mechanism remains elusive, several hypotheses have been proposed, including neurocirculatory reflex, growth hormone and megakaryocyte/platelet clump [45]. It is important to differentiate between clubbing and hypertrophic osteoarthropathy, which may resemble clubbing but is distinguished from clubbing by the presence of a painful nail bed, while clubbing is asymptomatic. Hypertrophic osteoarthropathy is associated with the paraneoplastic syndrome of several malignancies, including primary liver cancer [46].
Elephantiasis in a patient with thyroid eye disease
Published in Orbit, 2022
Darius D. Bordbar, Ann Q. Tran, Andrea A. Tooley, Michael Kazim
A 29-year-old man with Graves disease presented with a 6-month history of bulging eyes and upper and lower extremity skin changes. The patient previously underwent radioactive iodine ablation and at the time of presentation was receiving levothyroxine and was euthyroid. There was no family history of Graves disease or thyroid eye disease (TED) and the patient was a non-smoker. Visual acuity was 20/20 bilaterally. There was no afferent pupillary defect. Ocular motility was moderately impaired in depression and abduction on the right and in elevation and abduction on the left. There was bilateral proptosis and upper and lower eyelid retraction with superior and inferior scleral show (Figure 1a). A computed tomography scan of the orbits demonstrated significantly enlarged extra-ocular muscles in a fusiform pattern (Figure 1b). Humphrey visual field testing was within normal limits. The patient’s fingers were uniformly swollen (Figure 1c), and the patient’s feet demonstrated non-pitting edema and cobblestone-appearing hyperkeratotic papulonodules (Figure 1d). A diagnosis of TED with associated infiltrative dermopathy producing acropachy and elephantiasis nostras verrucosa was made. The patient was given one dose of intravenous methylprednisolone with minimal improvement. Elephantiasis is an extremely rare manifestation of dermopathy. Its presence along with acropachy is often associated with severe TED that may require systemic immunosuppression.
Assessment of subclinical left ventricular dysfunction with speckle-tracking echocardiography in hyperthyroid and euthyroid Graves’ disease and its correlation with serum TIMP-1
Published in Acta Cardiologica, 2021
Irfan Veysel Duzen, Suzan Tabur, Sadettin Ozturk, Mert Deniz Savcilioglu, Enes Alıc, Mustafa Yetisen, Sıddık Sanli, Huseyin Goksuluk, Ertan Vuruskan, Gokhan Altunbas, Fatma Yılmaz Coskun, Mehmet Kaplan, Seyithan Taysi, Murat Sucu
The study enrolled 40 hyperthyroid patients with newly diagnosed Graves’ disease, 40 patients with Graves’ disease who were euthyroid for at least 6 months and 40 control subjects with no known illness and normal thyroid function tests (T3, T4 and TSH). Graves’ disease was diagnosed on the basis of thyroid function tests (high/normal serum free triiodothyronine (sT3) and free thyroxine (sT4) and low thyroid stimulating hormone (TSH) levels), increased thyroid-stimulating hormone receptor antibodies (TRAB) and the heterogeneous appearance of the thyroid parenchyma as demonstrated by ultrasound and medical history. Antithyroid drug (only methimazole) was used for treatment of the patients. Eighteen (18) of 40 patients have taken methimazole therapy in the euthyroid Graves’ group. Patients who were treated with radioactive iodine therapy, surgery or immunsupressive drugs were excluded from the study. In the hyperthyroid Graves’ patient group, echocardiography was performed in two days after diagnosis of Graves’ disease. Patients with known coronary artery disease, diabetes mellitus or hypertension, patients with segmental wall motion abnormality on echocardiography, patients with valvular heart disease, pregnant women, patients with known autoimmune disease, pulmonary disease, chronic renal disease or cancer were excluded. Patients with extrathyroidal manifestations of Graves' disease, Graves' orbitopathy, thyroid dermopathy and acropachy were also excluded from the study.