Fig 23.50a Thyroid acropachy: hand radiograph showing periosteal reaction and clubbing. Thyroid acropachy occurs as part of Graves' disease and consists of clubbing of the fingers and toes, usually associated with exophthalmos and pretibial myxoedema. Bone changes are not necessarily part of the syndrome although they are frequently present. The PA film of a hand shows the characteristic periosteal reaction of thyroid acropachy along the radial aspect of the shaft of the first metacarpal, the typical site. Soft tissue thickening is evident around some of the distal phalanges.
