Onycholysis occurring in the setting of hyperthyroidism is classically referred to as Plummer’s nails. This condition typically runs a chronic clinical course and may resolve or improve after treating the underlying cause1.

Clinical features of Plummer’s nails

Onycholysis has eponymously been referred to as “Plummer’s nails.” Dr. Henry Stanley Plummer of Mayo Clinic described this unique clinical finding in 1918. There are various characteristic features of dystrophic nails in hyperthyroidism, including the unique “scoop shovel” appearance and flattening of the fingernails2.

Plummer’s nails present as a separation of the distal aspect of the nail plate from its underlying nail bed (mainly involving its distal and lateral regions of the nail plate). It is an inconsistent physical finding and occurs in approximately 5% of patients with hyperthyroidism3.

Differential diagnoses of Plummer’s disease

There are various endocrine and non-endocrine causes of Plummer’s nails4

  • Psoriatic arthritis
  • Sarcoidosis
  • Syphilis
  • Trauma
  • Lung malignancy
  • Drugs (tetracyclines, bleomycin, paclitaxel, and fluoroquinolones)
  • Bronchiectasis
  • Hypothyroidism and Hyperthyroidism

Pathophysiology of Plummer’s nails

The cause of onycholysis remains unclear, although hyperthyroidism-induced catabolism and rapid growth of the underlying nail bed are possible reasons for the separation of the nail from the nail bed4.


  1. Malumani M, Zhu D, Wu J, Song J Quan. Onycholysis an early indicator of thyroid disease. PAMJ. 2019;32(31). doi:10.11604/pamj.2019.32.31.17653
  2. Luria MN, Asper SP JR. Onycholysis in hyperthyroidism. Ann Intern Med. 1958;49(1):102-108. doi:10.7326/0003-4819-49-1-102
  3. Atia A, Johnson B, Abdelmalak H, Sinnott B. Visual Vignette. Endocr Pract. 2008;14(1):132-132. doi:10.4158/EP.14.1.132
  4. Ghayee HK, Mattern JQA, Cooper DS. Dirty Nails. J Clin Endocrinol Metab. 2005;90(4):2428-2428. doi:10.1210/jc.2004-2439

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