What is thyroid acropachy?

Thyroid acropachy is a complex and rare thickening of the extremities that occasionally happens in someone with Graves’ disease if they have been thyrotoxic. Someone is thyrotoxic if their thyroid gland has been overactive, producing too much thyroid hormones. This is the same as hyperthyroidism.

With thyroid acropachy there are three core signs which lead to diagnosis. Firstly, there will be digital clubbing. This means that the fingers and toes are thickened, perhaps described as sausage-like. Secondly, the soft tissues of the hands and feet will appear swollen (although not necessarily painful). Lastly, for thyroid acropachy to be diagnosed there will be periosteal new bone formation, meaning there is growth in the small membranes of blood vessels and nerves around the bones in the fingers and toes.

Thyroid acropachy is rare but it almost always happens alongside or in association with thyroid opthalmopathy and dermopathy.

Thyroid opthalmopathy and dermopathy

Untreated or uncontrolled hyperthyroidism or Graves’ disease may lead to thyroid opthalmopathy. This is sometimes known as thyroid eye disease (TED). It is also sometimes referred to as Graves’ opthalmopathy or orbitopathy. It is characterized by inflammation around the eye, leading to a bulging look. Around a quarter of people with Graves’ disease experience related eye problems.

Thyroid dermopathy is a thickening of the skin usually on the lower legs. It may also spread to the feet. The skin may have an orange peel appearance and texture, as well as seeming waxy and discolored. Thyroid dermopathy usually only presents in someone who is already experiencing symptoms of thyroid opthalmopathy.

Both thyroid opthalmopathy and dermopathy are indications that your thyroid remains overactive and further treatment may be necessary, to prevent further complications such as thyroid acropachy or a thyroid storm.

Can you treat thyroid acropachy?

Unfortunately, there are no known treatments for thyroid acropachy. While it is usually painless, this lack of treatment is still frustrating and swollen fingers and toes can cause discomfort and difficulties with the activities of daily living.

Some treatments for thyroid acropachy include using steroids, radiotherapy, immunosuppressive drugs and even surgery. However, these aren’t cures.

As such, it is best to do everything possible to prevent developing thyroid acropachy wherever possible. This means doing the best you can to effectively manage Graves’ disease and take swift action in the event that you develop thyroid opthalmopathy or thyroid dermopathy.

Graves’ disease

Graves’ disease is an autoimmune disorder. With Graves’ disease, the thyroid is overactive and produces too much of the different thyroid hormones (hyperthyroidism). Hyperthyroidism can have different causes but it is most commonly caused by Graves’ disease. Graves’ disease is more likely in women and those under 40.

With Graves’ disease, there are many different symptoms. The thyroid is responsible for systemic and metabolic health and so as a result the symptoms are diverse. Common symptoms include anxiety, tremors, heat sensitivity, weight loss, palpitations, bulging, red or inflamed eyes, sleep difficulties and development of a goiter.

By reducing the amount of thyroid hormones in the body the symptoms of Graves’ disease can be managed and things like thyroid acropachy, opthalmopathy and dermopathy become less likely to occur.

Unfortunately, there’s currently no known way to prevent Graves’ disease. There is a genetic component but the pattern remains unclear.

How to treat Graves’ disease

The goal of all Graves’ disease treatment is to stop the production of thyroid hormones. This may be done in a few different ways:

Radioactive iodine therapy

Orally taken radioiodine destroys overactive thyroid cells. It is not usually recommended if you already have symptoms of Graves’ opthalmopathy.

Anti-thyroid medications

Anti-thyroid medications prevent the thyroid using iodine to make hormones. These medications include propylthiouracil and methimazole.

Beta blockers

Beta blockers, like propranolol, block the effects of thyroid hormones on the body. They are especially useful for dealing with some of the more troublesome symptoms of hyperthyroidism, such as palpitations.

Surgery

Surgery to remove your thyroid gland (or part of it) is a typical treatment for Graves’ disease.

Especially with surgery, but also with other treatments, it is likely that you will develop hypothyroidism. While too many thyroid hormones cause the problems of Graves’ disease, hypothyroidism causes problems too. In this case, your doctor will prescribe thyroid medications, such as levothyroxine to replace your missing hormones at a better level.

Thyroid acropachy is a rare and mostly benign condition affecting those with Graves’ disease who already present with thyroid opthalmopathy and dermopathy. Effective treatment of hyperthyroidism can help to prevent it.

International Pharmacy provides general information which is not a substitute for personal medical guidance and advice. Speak to your doctor if you think you have signs of thyroid disease, including the signs of thyroid acropachy.