Thyroid acropachy is a rare (1%) complication of Graves’ disease consisting of soft tissue swelling of the hands, digital clubbing, and periostitis, particularly involving the metacarpal and phalangeal bones. Radiographs are characteristic. It is strongly associated with ophthalmopathy, cigarette use, and myxedema (common pretibial location; indurated, woody texture of skin with overlying nodules composed of hyaluronic acid that are ≥1 cm). The symptoms usually occur after the patient becomes euthyroid. Pain is variable but usually mild and does not tend to persist chronically. There is no effective therapy other than symptom control.