Ultrasonographic appearance of thyroid acropachy



Illustration 1.

The patient, a 61-year-old woman with longstanding Graves' disease with Graves' ophthalmopathy, presented with bilateral finger swelling and stiffness (A). Radiographs of the hand and wrist (B) showed nodular fibrosis of the periosteal areas with subperiosteal bone formation consistent with a diffuse, solid, and thick periosteal reaction (arrows). A higher-magnification view of the right small finger (C) highlights these changes more clearly (arrow). Ultrasound imaging (D) of the boxed area in B corroborated the findings of periosteal reaction, which were seen as irregular areas of bone formation protruding from the cortex (black arrow) along the shafts of the long bones of the hands, with hypoechoic material seen superficial to the bone, consistent with periosteal edema (white arrows). The dashed line indicates the expected bony contour of the cortex. The changes were most pronounced in the small finger and metacarpal bones of the right hand. Thyroid acropachy is a rare complication of thyroid disease, which most often occurs in patients with longstanding, active Graves' disease accompanied by ophthalmopathy and dermopathy (Batal O, Hatem SF. Radiologic case study: thyroid acropachy. Orthopedics 2008;2:98–100). Digital clubbing, soft tissue swelling, and pain are usually present. Treatment includes the management of thyroid dysfunction and the administration of immunosuppressive agents.