Thyroid dermopathy and acropachy

Graves' disease is an autoimmune condition with extrathyroidal immune-mediated manifestations, including ophthalmopathy and dermopathy. Dermopathy, or pretibial myxedema, typically occurs in patients with ophthalmopathy. The presence of high levels of thyrotropin receptor antibodies indicates a more severe autoimmune process. Diagnosis is on recognition of clinical features; skin biopsy may be needed in some cases. One in four patients with thyroid dermopathy, usually occurring in the pretibial area, has acropachy and digital clubbing. Localization to the pretibial area is most likely due to dependency and mechanical factors. Rarely, upper body involvement occurs, usually triggered by trauma. Mild cases resolve over time. Moderate or severe cases require local corticosteroid therapy. Severe cases, including elephantiasis, are usually persistent and mimic lymphedema.