Acropachy and pretibial myxedema

Wednesday my endocrinologist suggested that I may have some form of dermopathy (skin abnormality) and perhaps the beginnings of pretibial myxedema and acropachy.

Pretibial myxedema is a deposition of a mucinous substance in the skin of the shins, basically, thanks (or no thanks) to autoimmune attacks upon susceptible tissue there. It takes all kinds of forms, including one that looks like elephantiasis. The most common form in one study appeared to be nonpitting edema. Nonpitting edema is also known as "brawny" edema, and might describe the slight swelling of my own shins, especially the left one.

Acropachy describes clubbing of the fingers (and sometimes toes), as well as skin and joint changes in the fingers. X-rays will show fuzzy looking bony growths of the fingers and sometimes other long bones. Sometimes the fingers don't club at all . . . they just hurt.

What my endo found in addition to the puffy shins were overly fleshy hands. It led him, last December, to test me for excess growth hormone. He suspected acromegaly, though what he found was a deficiency of growth hormone, which may or may not be related to the thyroid stuff.

Now he thinks that the fleshy palms and sore distal finger joints may point to acropachy.

I read a little more about it and found out that most acropachy doesn't hurt, but when it does, the pain is frequently intermittent (Check), and in the distal joints (Check). Clubbing of the fingernails may not occur, or then again, the whole hands may be affected by swelling (Check).

Pretibial myxedema most commonly manifests itself as the brawny edema, thought it may be discolored or wartyin texture. Both it and acropachy are most common in people currently smoking, and in people with extremely high levels of TSI antibodies (My antibodies were "moderate"), and both PTM and acropachy represent the most extreme manifestations of Graves' disease.

Lucky me! The only thing that cheers me up is that the studies show that the joint pain disappears, and in a significant proportion of cases, the PTM and the acropachy improve or remit, given time.