Monday, March 12, 2012

Pachydermiostosis (2)

Pachydermiostosis (2)

We have seen a patient aged 46 years in February 1995. He complained about soft tissue swelling of the hands without pain or reddening, but with a feeling of tension. First time he was aware of this had been during February 1994. End of 1992 M. Basedow (Graves’ disease) was diagnosed (typical symptoms of hyperthyreoidism, typical antibody findings). He has been treated with carbimazole for about a year, followed by radioiodine therapy. With increasing symptoms despite therapy he has been thyreoidectomied sub totally in December 1993. Substitution with LT4 immediately after surgery in a dosage of 75 µg, increased to 125 µg in January, and further to 150 µg in February 1994. In September 1994 TSH-receptor-Antibodies were elevated at 472 µU/ml.
In the rheumatologic examination we saw all fingers swollen and hour glass nails without drum flail fingers.
X-rays showed a thickening of the cortical bone. (All X-ray charts have been destroyed according to restrict archive space)
Interestingly he been outside of Germany for longer spells because of his work leading him to Saudi Arabia, Libya, Brazil, Ethiopia, and others, prior to his disease.

Any questions ?

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