Thyroid acropachy: A rare skeletal manifestation of autoimmune thyroid disease

Jadidi, Jami; Sighary, Maziar; Efendizade, DO Aslan; Grigorian, Arkadij; Lehto, Scott A.; Kolla, Srinivas

doi:10.1016/j.radcr.2019.04.021

Cited by 9 publications

(7 citation statements)

References 6 publications

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“…A prevalence of GD is approximately 1% to 1.5%, with an incidence ranging from 20 to 30 new cases/100,000/year [ 2 ]. TRAb may exhibit a high affinity not only to the thyroid gland but also to other tissues, including eyes (orbitopathy), skin (dermatopathy) and bone and muscles (acropachy) [ 2 , 3 ]. Graves’ orbitopathy (GO), which is the most important extrathyroidal manifestation of GD, presents with lid retraction, exophthalmos, soft tissue involvement of the eye, spontaneous retrobulbar pain and pain on an attempted upward or downward gaze [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Novel Insight into Non-Genetic Risk Factors of Graves’ Orbitopathy

Zawadzka-Starczewska

Stasiak

Wojciechowska-Durczynska

et al. 2022

IJERPH

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An assessment of the risk of Graves’ orbitopathy (GO) is an important challenge in Graves’ disease (GD) management. The purpose of this study was to compare non-genetic parameters in GD patients with and without GO in order to find novel risk factors and to verify the factors already reported. A total number of 161 people, 70 with GO and 91 non-GO patients were included in this study. GO was confirmed to be associated with smoking, older age, higher TSH receptor antibodies (TRAb) and lower thyroglobulin antibody (TgAb) levels and hypercholesterolemia. We demonstrated the latter correlation even for only a mild increase in LDL cholesterol. Importantly, our study provides novel potential GO risk factors, including higher serum creatinine levels, higher MCV and lower PLT. If further confirmed, these new, simple and easily accessible potential GO markers may constitute valuable auxiliary markers in GO risk assessments. We additionally proved that in moderate to severe GO, gender-related differences attenuate. No impact of vitamin D deficiency in GO development in patients with 25-hydroxyvitamin D [25(OH)D] > 20 ng/mL was found. The present report provides a set of GO risk factors, which can be used as a precise tool for an individual GO risk assessment.

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Section: Introductionmentioning

confidence: 99%

Novel Insight into Non-Genetic Risk Factors of Graves’ Orbitopathy

Zawadzka-Starczewska

Stasiak

Wojciechowska-Durczynska

et al. 2022

IJERPH

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“…For the chronological sequence of extrathyroidal manifestations of AITD, thyroid dysfunction develops first, followed by ophthalmopathy, dermopathy, and finally, acropachy. 17 , 18 TA can occur in hyperthyroid, euthyroid or hypothyroid patients. 17 , 18 Radiological study reveals periosteal reactions predominantly in metacarpals and phalanges of the fingers, and rarely in long bones.…”

Section: Discussionmentioning

confidence: 99%

“… 17 , 18 TA can occur in hyperthyroid, euthyroid or hypothyroid patients. 17 , 18 Radiological study reveals periosteal reactions predominantly in metacarpals and phalanges of the fingers, and rarely in long bones. 10 , 19 In this case, the patient was diagnosed with PDP due to facial disfigurement, digital clubbing and the periostosis of the long bones, although a pituitary microadenoma was found.…”

Section: Discussionmentioning

confidence: 99%

A Complete Form of Pachydermoperiostosis Accompanied by a Pituitary Microadenoma

Chen¹,

Li²

2023

CCID

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Pachydermoperiostosis is a rare genetic disease that is associated with HPGD (15-hydroxyprostaglandin dehydrogenase) and SLCO2A1 (solute carrier organic anion transporter family member 2A1) gene mutations. It is characterized by three major phenotypes, namely, pachydermia, periostosis, and digital clubbing. Clinically, misdiagnoses such as acromegaly and thyroid acropachy are commonly confused with pachydermoperiostosis. Integral medical history, physical examination, endocrinological tests, and multiple disciplinary cooperation are extremely significant in the accurate diagnosis of pachydermoperiostosis. The co-existence of pachydermoperiostosis and pituitary adenoma is rarely recorded and discussed. In this case, we present a young male patient with a complete form of pachydermoperiostosis and a nonfunctional pituitary microadenoma, which has rarely been reported.

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“…One of the complications that occur after the treatment of thyrotoxicosis is thyroid acropathy. It is characterized by diffuse soft tissue edema, digit clubbing, and irregular and spiculated periosteal new bone formation, but no pain ( 7 ). In our case, the patient presented with severe pain in the hand and forearm, and arthralgia in multiple joints.…”

Section: Discussionmentioning

confidence: 99%

Antithyroid arthritis syndrome caused by methimazole in a patient with Graves’ disease

Kawasumi

Kubota

Yoshii

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary This is a report on antithyroid arthritis syndrome (AAS) which is a rare adverse effect of antithyroid agents. AAS presents with severe symptoms including myalgia, arthralgia, arthritis, fever, and skin eruption due to the use of antithyroid agents. We encountered a 55-year-old woman with severe pain in the hand and forearm and arthralgia in multiple joints, including the knee, ankle, hand, and wrist on day 23 after initiation of methimazole (MMI) for Graves’ disease. Blood tests revealed elevated inflammation markers such as C-reactive protein and interleukin-6, and magnetic resonance imaging of the hands confirmed inflammation findings. After withdrawing MMI on day 25, symptoms showed a tendency toward improvement. Afterwards, inflammation markers also dropped to an almost normal range. In addition to the above findings, the absence of anti-neutrophil cytoplasmic antibodies and most vasculitis symptoms such as nephritis, skin, or pulmonary lesions led to the diagnosis of AAS. A resolution of symptoms, except for mild arthralgia in the second to fourth fingers of the right hand, was observed 61 days after discontinuation of MMI. Although the pathogenesis is unclear, the positive drug lymphocyte stimulation test for MMI and the several weeks before the onset of AAS suggested involvement of a type IV allergic reaction. Based on a discussion of definitive treatment for Graves’ disease, radioactive iodine ablation with 131I, which was selected by the patient, was performed and improved her thyroid function. Our case demonstrates the importance of awareness regarding AAS, which is a rare and under-recognized, but life-threatening adverse effect of antithyroid agents. Learning points Clinicians should be aware of the possibility of developing antithyroid arthritis syndrome (AAS) in patients treated with antithyroid medications, which can lead to severe migratory polyarthritis. Prompt cessation of the antithyroid agent is essential for the resolution of AAS. Anti-neutrophil cytoplasmic antibody (ANCA) negativity is needed to differentiate from antithyroid agent-induced ANCA-associated vasculitis, which shows arthritis similar to AAS.

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Thyroid acropachy: A rare skeletal manifestation of autoimmune thyroid disease

Cited by 9 publications

References 6 publications

Novel Insight into Non-Genetic Risk Factors of Graves’ Orbitopathy

Novel Insight into Non-Genetic Risk Factors of Graves’ Orbitopathy

A Complete Form of Pachydermoperiostosis Accompanied by a Pituitary Microadenoma

Antithyroid arthritis syndrome caused by methimazole in a patient with Graves’ disease

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