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      Onycholysis an early indicator of thyroid disease

      case-report

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          Abstract

          Onycholysis is also referred to plummer's nails is a dermatological nail disorder characterized by spontaneous distal separation of the nail plate from the free margin and progressively proximally. We discuss a case of the 38-year-old man with onycholysis associated with hyperthyroidism due to Graves' disease. In this case review, we will discuss an association of onycholysis with thyroid disease and its diagnostic prognosis. Any unexplained onycholysis should prompt the clinician to investigate the client for asymptomatic hyperthyroidism.

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          Most cited references17

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          Dermatologic manifestations of endocrine disorders.

          Michael Lause, Alisha Kamboj, Esteban Fernandez Faith (2017)
          The skin serves as a window for clinicians to understand, diagnose, and monitor endocrine disease. Dermatologic manifestations of endocrinopathies contribute significantly to an individual's health and quality of life. In this review, we outline various disorders of the hypothalamic-pituitary axis, thyroid gland, pancreas, adrenal gland, and androgen axis as well as hereditary endocrine syndromes. In acromegaly, glycosaminoglycan deposition contributes to a thickening of skin and soft tissue, which manifests as coarsening and enlargement of facial and acral structures. Stimulation of the thyrotropin receptor in hyperthyroidism results in mesenchymal tissue proliferation and consequent pretibial myxedema; other associated cutaneous features include onycholysis, and hyperhidrosis. Individuals with hypothyroidism exhibit cold, dry skin and brittle hair as well as a jaundice-like appearance due to carotene excess. The cutaneous features of diabetes mellitus (DM), mediated to a large extent by hyperglycemia and hyperinsulinemia, include necrobiosis lipoidica diabeticorum (NLD), diabetic dermopathy, and acanthosis nigricans. Pediatric patients with Cushing's syndrome almost invariably present with truncal obesity and growth retardation; disruption of collagen formation and the catabolic effects of hypercortisolism result in skin atrophy and purple abdominal striae. In patients with Addison's disease, generalized hyperpigmentation, secondary to elevated levels of melanocyte-stimulating hormone (MSH), is most prominent in sun-exposed areas. Due to hyperandrogenism, individuals with polycystic ovarian syndrome (PCOS) often exhibit hirsutism, acne vulgaris, and androgenetic alopecia. In multiple endocrine neoplasia (MEN) syndromes, specific gene mutations may lead to angiofibromas, lichen amyloidosis, and ganglioneuromas. Disruptions of immune regulation result in autoimmune polyglandular syndromes (APS) and associated clinical features including chronic mucocutaneous candidiasis, vitiligo, and alopecia areata. This paper highlights the underlying pathophysiology, dermatologic manifestations, and treatment of the aforementioned endocrine disorders.
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            Nail abnormalities: clues to systemic disease.

            S Fawcett, S D Stulberg, Alicia Linford (2004)
            The visual appearance of the fingernails and toenails may suggest an underlying systemic disease. Clubbing of the nails often suggests pulmonary disease or inflammatory bowel disease. Koilonychia, or "spoon-shaped" nails, may stimulate a work-up for hemochromatosis or anemia. In the absence of trauma or psoriasis, onycholysis should prompt a search for symptoms of hyperthyroidism. The finding of Beau's lines may indicate previous severe illness, trauma, or exposure to cold temperatures in patients with Raynaud's disease. In patients with Muehrcke's lines, albumin levels should be checked, and a work-up done if the level is low. Splinter hemorrhage in patients with heart murmur and unexplained fever can herald endocarditis. Patients with telangiectasia, koilonychia, or pitting of the nails may have connective tissue disorders.
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              Thyrotropin Receptor Antibodies-An Overview.

              Anupam Kotwal, Marius Nicolae Stan (2018)
              Thyroid autoimmunity affects approximately 5% of the population, and its investigation relies heavily on the use of autoantibodies. Thyroid stimulating hormone receptor (TSHR) autoantibodies (TRAb) play a central role in the evaluation of Graves disease (GD), Graves ophthalmopathy (GO) and pretibial myxedema (PTM). However, there is still controversy regarding overall TRAb assay diagnostic accuracy and their prognostic utility.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pan Afr Med J
                Journal ID (iso-abbrev): Pan Afr Med J
                Journal ID (publisher-id): PAMJ
                Title: The Pan African Medical Journal
                Publisher: The African Field Epidemiology Network
                ISSN (Electronic): 1937-8688
                Publication date (Electronic): 17 January 2019
                Publication date Collection: 2019
                Volume: 32
                Electronic Location Identifier: 31
                Affiliations
                [1 ]Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University PR China
                [2 ]Livingstone Central Hospital, Southern Zambia
                [3 ]Department of Endocrinology at Zhongnan Hospital of Wuhan University Hubei, China
                [4 ]Dermatology and Venereology at Zhongnan Hospital of Wuhan University Hubei, China
                Author notes
                [& ]Corresponding author: Song Ji Quan, Dermatology and Venereology at Zhongnan Hospital of Wuhan University Hubei, China
                Article
                Publisher ID: PAMJ-32-31
                DOI: 10.11604/pamj.2019.32.31.17653
                PMC ID: 6522173
                SO-VID: 1320baec-6352-4e85-8866-480daa52e4f7
                Copyright © © Malumani Malan et al.
                License:

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 November 2018
                Date accepted : 15 January 2019
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: onycholysis,plummer´s nails,thyroid disease,hypothyroidism,hyperthyroidism,graves´ disease
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: onycholysis, plummer´s nails, thyroid disease, hypothyroidism, hyperthyroidism, graves´ disease

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