Fig 23.50b 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 coned view of the thumb and first metacarpal demonstrates the characteristic lace-like appearance of the periosteal reaction. Besides the typical involvement of the first metacarpal, periosteal new bone formation may also occur along the shafts of other metacarpals and the proximal phalanges. In this patient, a slight periosteal reaction is also present along the shaft of the proximal phalanx of the thumb.
