Fatourechi Vahab, Ahmed Debra D F, Schwartz Kara M
Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Clin Endocrinol Metab. 2002 Dec;87(12):5435-41. doi: 10.1210/jc.2002-020746.
Thyroid acropachy is an extreme manifestation of autoimmune thyroid disease. It presents with digital clubbing, swelling of digits and toes, and periosteal reaction of extremity bones. It is almost always associated with ophthalmopathy and thyroid dermopathy. During a 26-yr period at our institution, of 178 patients with thyroid dermopathy, 40 had acropachy. Clubbing associated with thyroid dermopathy (pretibial myxedema) was seen in 35 patients. Clubbing usually was not a patient complaint and was noted only by clinical observers. Four of eight patients with hand and extremity radiographs had periosteal reaction. Seven had associated extremity and joint pain; this pain was absent at long-term follow-up. Half of the patients required systemic corticosteroid therapy, 53% required transantral or transfrontal orbital decompression for severe ophthalmopathy, and 18% had the elephantiasic form of dermopathy. Cigarette-smoking rates were 81% for women and 75% for men (mean, 28 pack-years). All 13 patients who had thyroid-stimulating Ig measurement had high titers. Long-term follow-up (median, 12.5 yr) revealed that acropachy was not a complaint in follow-up visits or questionnaires. The data suggest that thyroid acropachy is an indicator of severity of ophthalmopathy and dermopathy. It is a source of clinical concern only if dermopathy is persistent and severe.
甲状腺杵状指是自身免疫性甲状腺疾病的一种极端表现形式。其特征为手指杵状变、手指和足趾肿胀以及四肢骨骼的骨膜反应。它几乎总是与眼病和甲状腺皮肤病相关。在我们机构的26年期间，178例甲状腺皮肤病患者中，40例有杵状指。35例患者出现与甲状腺皮肤病（胫前黏液性水肿）相关的杵状指。杵状指通常并非患者的主诉，而是仅由临床观察者发现。8例进行手部和四肢X线检查的患者中有4例有骨膜反应。7例伴有四肢和关节疼痛；这种疼痛在长期随访中消失。一半的患者需要全身糖皮质激素治疗，53%因严重眼病需要经鼻窦或经额眶减压，18%有象皮肿样的皮肤病。女性吸烟率为81%，男性为75%（平均28包年）。所有13例检测促甲状腺素Ig的患者其滴度均高。长期随访（中位时间12.5年）显示，随访就诊或问卷调查中未提及杵状指。数据表明甲状腺杵状指是眼病和皮肤病严重程度的一个指标。仅当皮肤病持续且严重时，它才是临床关注的一个问题。
