Perini Nicolas, Santos Roberto Bernardo, Romaldini João Hamilton, Villagelin Danilo
AACE Clin Case Rep. 2019 Aug 14;5(6):e369-e371. doi: 10.4158/ACCR-2018-0591. eCollection 2019 Nov-Dec.
The objective of this report was to describe a patient with Graves acropachy, a rare manifestation of Graves disease (GD) that is clinically defined by skin tightness, digital clubbing, small-joint pain, and soft tissue edema progressing over months or years with gradual curving and enlargement of the fingers.
The patient was evaluated regarding thyroid function (serum free T4 [FT4] and thyroid-stimulating hormone [TSH] quantifications) and autoimmunity biomarkers (thyroid receptor antibody [TRAb]) as well as radiographic investigation of the extremities.
A 52-year-old man presented with a history of thyrotoxicosis and clinical signs of Graves orbitopathy. Laboratory tests showed suppressed TSH (0.01 UI/L; normal, 0.4 to 4.5 UI/L) and elevated serum FT4 (7.77 ng/dL; normal, 0.93 to 1.7 ng/dL), with high TRAb levels (40 UI/L; normal, <1.75 UI/L). A diagnosis of thyrotoxicosis due to GD was made and the patient was treated with methimazole. After the patient complained of swelling in hands and feet, X-ray evaluation was conducted and established the thyroid acropachy.
We present a case of a patient with GD associated with worsening extrathyroid manifestations during orbitopathy, dermopathy, and developed acropachy in hands and feet.
本报告旨在描述一名患有格雷夫斯病性杵状指的患者，这是格雷夫斯病（GD）的一种罕见表现，临床上表现为皮肤紧绷、杵状指、小关节疼痛和软组织水肿，在数月或数年中逐渐进展，手指逐渐弯曲和增粗。
对该患者进行了甲状腺功能（血清游离T4[FT4]和促甲状腺激素[TSH]定量）、自身免疫生物标志物（甲状腺受体抗体[TRAb]）评估以及四肢的影像学检查。
一名52岁男性，有甲状腺毒症病史及格雷夫斯眼病的临床体征。实验室检查显示促甲状腺激素降低（0.01 UI/L；正常范围为0.4至4.5 UI/L），血清游离T4升高（7.77 ng/dL；正常范围为0.93至1.7 ng/dL），甲状腺受体抗体水平较高（40 UI/L；正常范围<1.75 UI/L）。诊断为GD所致甲状腺毒症，患者接受甲巯咪唑治疗。患者主诉手脚肿胀后，进行了X线评估，确诊为甲状腺性杵状指。
我们报告了一例GD患者，在眼病、皮肤病期间甲状腺外表现恶化，并出现了手脚杵状指。
