Thyroid acropachy is a rare complication of thyroid disease most often occurring in patients with a long history of active Graves' disease with ophthalmopathy and dermopathy already present. It presents with digital clubbing and soft tissue swelling with possible pain in the digits. Plain radiographs show a solid periosteal reaction that tends to be bilateral and generally symmetrical involving the tubular bones of the hands and feet. Treatment is directed at the thyroid dysfunction and the accompanying ophthalmopathy and dermopathy. It is important to recognize the association with a more severe ophthalmopathy. In the absence of Graves' ophthalmopathy and dermopathy, a diligent search for other causes of acropachy is warranted.