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• The differential diagnosis of the condition of a patient with acral thickening and normal bone roentgenograms but without obvious signs of Graves' disease may be perplexing. A patient was seen with this disorder, in which the early diagnosis of thyroid acropachy could not be made roentgenographically but was accomplished by bone-scanning techniques. To our knowledge, this is the first demonstration of the evolution of thyroid acropachy, as temporally proved by serial roentgenograms and bone radiographs. The patient complained of severe swelling and decreased finger mobility. His hands were treated in a novel manner, using fluorinated topical steroids under an occlusive dressing, because of the failure of previously described localized medical therapeutic regimens. Treatment, using one hand as a control, resulted in a substantial decrease in hand circumference and volume, as well as increased finger mobility.(Arch Intern Med 1982;142:1749-1751)