Response to Letter Regarding Article, “Digital Clubbing”
2013; Lippincott Williams & Wilkins; Volume: 128; Issue: 23 Linguagem: Inglês
10.1161/circulationaha.113.005707
ISSN1524-4539
Autores Tópico(s)Connective tissue disorders research
ResumoHomeCirculationVol. 128, No. 23Response to Letter Regarding Article, "Digital Clubbing" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter Regarding Article, "Digital Clubbing" John D. Rutherford, MB ChB, FRACP John D. RutherfordJohn D. Rutherford Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX Originally published3 Dec 2013https://doi.org/10.1161/CIRCULATIONAHA.113.005707Circulation. 2013;128:e449I appreciate the comments about the article on digital clubbing.1 The authors correctly point out that thyroid, and parathyroid, disease have been associated with clubbing. Danforth and Humphrey described the association of Graves' disease, pretibial myxedema (thyroid dermopathy), and exophthalmos in 1958.2 What we now describe as autoimmune thyroid disease has these associations that tend to occur together. Interestingly, increased levels of vascular endothelial growth factor have been seen in untreated Graves' disease and goitrous Hashimoto thyroiditis and have been associated with increased tissue vascularity and gland size.3 In cultures of human thyrocytes, increased transcription and protein expression of vascular endothelial growth factor, and its receptors, have been detected in goiter tissue and the highest levels seen in Graves disease.4 So, as in other conditions described with digital clubbing, release of signal proteins such as vascular endothelial growth factor and stimulation of angiogenesis are probably contributory. More importantly, increased expression of vascular endothelial growth factor and its receptors is seen in thyroid cancer5 and is 1 of the targets for cancer therapy.6 In the descriptive clinical vignette, the patient was euthyroid, without a goiter or evidence of thyroid dermopathy or ophthalmopathy.John D. Rutherford, MB ChB, FRACPDivision of Cardiology, Department of Internal MedicineUT Southwestern Medical CenterDallas, TXSources of FundingDr Rutherford is supported by the Jonsson-Rogers Chair in Cardiology.DisclosuresNone.References1. Rutherford JD. Digital clubbing.Circulation. 2013; 127:1997–1999.LinkGoogle Scholar2. Danforth WH, Humphrey HA. Hypertrophic osteoarthropathy and pretibial myxedema associated with Graves' disease.J Clin Endocrinol Metab. 1958; 18:1302–1307.CrossrefMedlineGoogle Scholar3. Iitaka M, Miura S, Yamanaka K, Kawasaki S, Kitahama S, Kawakami Y, Kakinuma S, Oosuga I, Wada S, Katayama S. Increased serum vascular endothelial growth factor levels and intrathyroidal vascular area in patients with Graves' disease and Hashimoto's thyroiditis.J Clin Endocrinol Metab. 1998; 83:3908–3912.MedlineGoogle Scholar4. Malkomes P, Oppermann E, Bechstein WO, Holzer K. Vascular endothelial growth factor: marker for proliferation in thyroid diseases?Exp Clin Endocrinol Diabetes. 2013; 121:6–13.CrossrefMedlineGoogle Scholar5. Capp C, Wajner SM, Siqueira DR, Brasil BA, Meurer L, Maia AL. Increased expression of vascular endothelial growth factor and its receptors, VEGFR-1 and VEGFR-2, in medullary thyroid carcinoma.Thyroid. 2010; 20:863–871.CrossrefMedlineGoogle Scholar6. Perez CA, Santos ES, Arango BA, Raez LE, Cohen EE. Novel molecular targeted therapies for refractory thyroid cancer.Head Neck. 2012; 34:736–745.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails December 1, 2013Vol 128, Issue 23 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.113.005707PMID: 24297822 Originally publishedDecember 3, 2013 PDF download Advertisement SubjectsEndothelium/Vascular Type/Nitric OxideVascular Biology
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