Letter by De Mattia et al Regarding Article, “Digital Clubbing”
To the Editor:
In the first part of his very interesting Clinician Update focused on digital clubbing (DC),1 Rutherford described the case of a patient presenting with a 3-month history of significant weight loss, occasional night sweats, and fatigue, in whom physical examination revealed a fast resting heart rate and bilateral DC.
The author subsequently listed the major causes to consider in a patient with DC and discussed current knowledge of the pathophysiology. The patient’s definitive diagnosis was lung adenocarcinoma.
Although not mentioned in the article, metabolic conditions such as Graves disease, thyroid acropachy, and, less often, severe hyperparathyroidism have all been described as possible causes of DC.2 Fatourechi et al3 reported that in a cohort of 178 patients with autoimmune thyroid disease and thyroid dermopathy, 35 had DC, and in 5 patients, DC occurred ≥3 months before dermopathy developed. The presence of isolated thyroid disease–related DC without dermopathy has also been reported.4 Moreover, loss of weight, high resting heart rate, fatigue, and increased sweating may all be found in patients with hyperthyroidism.5
We therefore respectfully suggest that in a clinical scenario similar to the one described by Rutherford, hyperthyroidism should be kept in mind in the differential diagnosis, and assessment of thyroid-stimulating hormone blood levels should be considered part of routine blood tests, before more potentially harmful and expensive tests (eg, computed tomography of the chest) are planned.
Luca De Mattia, MD
Gian Luigi Rellini, MD
Gian Luigi Nicolosi, MD, FESC, FACC
Department of Cardiology ARC
Azienda Ospedali Riuniti del Pordenonese
- © 2013 American Heart Association, Inc.
- Rutherford JD
- Porter R