1
|
Hs K, Cheemalapati S, Cr V. Hoffmann's syndrome in subclinical hypothyroidism. J R Coll Physicians Edinb 2024; 54:26-28. [PMID: 38078406 DOI: 10.1177/14782715231218033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Hypothyroidism is an endocrine disorder which occurs due to a deficiency of thyroid hormones. Hoffmann's syndrome is a rare complication of hypothyroidism - presenting as hypothyroid myopathy. We describe the case of a 20-year-old lactating female, known to have hypothyroidism (diagnosed during her pregnancy and having discontinued treatment following delivery), presenting with complaints of pain, swelling of bilateral calf muscles with cramps in bilateral lower limbs. Symptoms of muscle pseudohypertrophy with muscle stiffness are relatively rare in subclinical hypothyroidism and it is important to identify and diagnose this rare condition, and initiate appropriate treatment.
Collapse
Affiliation(s)
- Kiran Hs
- Department of General Medicine, JSS Medical College and Hospital, Mysuru, India
| | | | - Venkatesh Cr
- Department of General Medicine, JSS Medical College and Hospital, Mysuru, India
| |
Collapse
|
2
|
Rodolico C, Bonanno C, Pugliese A, Nicocia G, Benvenga S, Toscano A. Endocrine myopathies: clinical and histopathological features of the major forms. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2020; 39:130-135. [PMID: 33305169 PMCID: PMC7711326 DOI: 10.36185/2532-1900-017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
Endocrinopathies, such as thyroid and parathyroid diseases, disorders of the adrenal axis, and acromegaly are included among the many causes of myopathy. Muscle disturbances caused by endocrine disorders are mainly due to alterations in the protein and carbohydrate metabolisms. Either a deficiency or excess of hormones produced by the glands can cause muscle dysfunction that can be reversed by starting hormone replacement therapy or acting on hormone dysfunction. The diagnosis is usually easy if a muscle disorder occurs in an overt endocrinopathy; however, in few patients, myopathy could be the first manifestation of the underlying endocrinopathy. In this article we discuss pathophysiology, clinical features and management of muscle involvement related to the major endocrine diseases.
Collapse
Affiliation(s)
- Carmelo Rodolico
- Correspondence Carmelo Rodolico Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Disease, University of Messina, via Consolare Valeria 1, 98122 Messina, Italy. Tel.: +39 090 2213501. E-mail:
| | | | | | | | | | | |
Collapse
|
3
|
Moncayo R, Moncayo H. The WOMED model of benign thyroid disease: Acquired magnesium deficiency due to physical and psychological stressors relates to dysfunction of oxidative phosphorylation. BBA CLINICAL 2014; 3:44-64. [PMID: 26675817 PMCID: PMC4661500 DOI: 10.1016/j.bbacli.2014.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/15/2014] [Accepted: 11/04/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to discern whether a relation between biochemical parameters, sonography and musculoskeletal data exists in cases of hyperthyroidism and whether they are modifiable through supplementation with selenomethionine and magnesium citrate as well as by acupuncture and manual medicine methods. RESULTS A direct correlation between whole blood selenium and serum magnesium was found in subjects without thyroid disease and in menopausal women while it was reversed in cases of thyroid diseases as well as in patients with depression, infection, and in infertile women. Vascularization indices were elevated in cases of newly diagnosed benign thyroid diseases. Musculoskeletal changes i.e. lateral tension and idiopathic moving toes, as well as situations of physical and psychological stress and minor trauma and infection led to an increase of vascularization. Magnesium levels correlated negatively with these two conditions. The supplementation brought a reduction of the vascularization indices and reduced the incidence of idiopathic moving toes. Treatment of lateral tension required manual medicine methods and acupuncture (gastrocnemius). A small subgroup of patients showed a further reduction of hyper-vascularization after receiving coenzyme Q10. CONCLUSIONS We interpret the elevated thyroid vascularization and low magnesium levels as signs of an inflammatory process related to the musculoskeletal changes. Improvement of thyroid function and morphology can be achieved after correcting the influence of stressors together with the supplementation regime. We hypothesize that the central biochemical event in thyroid disease is that of an acquired, altered mitochondrial function due to deficiency of magnesium, selenium, and coenzyme Q10.
Collapse
Affiliation(s)
- Roy Moncayo
- WOMED, Karl-Kapferer-Strasse 5, AT-6020 Innsbruck, Austria
| | - Helga Moncayo
- WOMED, Karl-Kapferer-Strasse 5, AT-6020 Innsbruck, Austria
| |
Collapse
|
4
|
Anwar S, Gibofsky A. Musculoskeletal Manifestations of Thyroid Disease. Rheum Dis Clin North Am 2010; 36:637-46. [DOI: 10.1016/j.rdc.2010.09.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Scott KR, Simmons Z, Boyer PJ. Hypothyroid myopathy with a strikingly elevated serum creatine kinase level. Muscle Nerve 2002; 26:141-4. [PMID: 12115960 DOI: 10.1002/mus.10128] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although serum creatine kinase (CK) levels are frequently modestly elevated in patients with hypothyroid myopathy, elevations in serum CK to the levels usually seen in inflammatory myopathies or dystrophies are rare. We report a patient with progressive proximal weakness and a serum CK level of over 29,000 IU/L, in whom subsequent laboratory evaluation identified profound hypothyroidism. Thyroid hormone replacement therapy resulted in resolution of clinical symptoms and a marked reduction in the serum CK level. Such a high serum CK level in a patient with hypothyroidism underscores the importance of assessing thyroid function in patients with weakness, regardless of serum CK levels, even when systemic symptoms and signs of hypothyroidism are minimal or absent.
Collapse
Affiliation(s)
- Kevin R Scott
- Division of Neurology, Penn State College of Medicine, Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania 17033, USA
| | | | | |
Collapse
|
6
|
Abstract
Polymyositis-like syndrome, with proximal muscle weakness and elevation of muscle enzymes, may be a clinical manifestation of hypothyroidism. To define the clinical, biochemical, electromyographic, and pathologic characteristics of patients with this syndrome, we identified and reviewed by MEDLINE all cases reported in the English literature from January 1, 1975 through December 31, 2000. Thirty-two cases were considered. Fifty-nine percent of the patients were male with a mean age of 54.7 +/- 22.6 years, (+/- 1 standard deviation [SD]). Weakness was described in 100% of patients. Other common clinical manifestations were: delayed tendon reflexes with slow relaxation phase (41%), muscle tenderness (25%), and muscle induration (9%). The mean creatine kinase (CK) was 2164 +/- 1954 U/L (+/- 1 SD) and the mean thyroid-stimulating hormone (TSH) was 114.8 +/- 85.6 mIU/L (+/- 1 SD). Fifty percent of patients had electromyography; half of the studies were normal while the other half showed nonspecific myopathic changes. Biopsies were performed in 80% of the patients. The most common findings were type II fiber atrophy, type I fiber hypertrophy, central nuclei disposition, necrosis, increased percentage of type I fibers, and decreased percentage of type II fibers, inflammatory infiltrate and the presence of core-like structures. The characteristics of polymyositis-like syndrome in hypothyroidism did not differ from those of nonspecific hypothyroid myopathy. Clinical judgment alone may not be sufficient to suspect and detect these patients. Serum TSH levels should be routinely determined in all patients with muscle weakness or elevation of creatine kinase.
Collapse
Affiliation(s)
- Miguel G Madariaga
- Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
| |
Collapse
|
7
|
Abstract
This article reviews the neuromuscular disorders associated with many endocrine disturbances. The severity of neuromuscular disorders varies. Some of these disturbances are mild, and others are severe and life threatening.
Collapse
Affiliation(s)
- Amer Alshekhlee
- Department of Neurology, Case Western Reserve University School of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, University Hospital of Cleveland, Cleveland, Ohio 44106, USA
| | | | | |
Collapse
|
8
|
Abstract
Muscle disease symptoms and myopathies are not uncommon in the elderly. Inflammatory and noninflammatory myopathies lead to proximal extremity or axial weakness and are superimposed on the intrinsic changes that occur in muscle with aging (sarcopenia). This article surveys the more common myopathies in the elderly based on a review of the process of sarcopenia, and how these age-related changes in muscle structure and function affect the results of the standard assessments of muscle disease in the elderly.
Collapse
Affiliation(s)
- K S O'Rourke
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
| |
Collapse
|
9
|
Abstract
Fifteen patients with primary hypothyroidism were evaluated neurologically. Needle biopsies of skeletal muscle were obtained using a Bergstrom needle. In 73% of the patients, cores were identified histologically and by electron microscopy in the skeletal muscle of these patients. The presence of cores correlated with the severity of hypothyroidism, muscle hypertrophy, cramps and the duration of the hypothyroid state. There was no significant correlation with muscle weakness. Immunofluorescence studies with N-CAM antibodies demonstrated staining of the sarcolemma, cytoplasm and central regions (cores) in the hypothyroid muscle. These imply that the presence of cores in hypothyroid myopathy is due to reactivation of embryonic proteins that disrupt skeletal muscle architecture.
Collapse
Affiliation(s)
- G Modi
- Neurology Unit, Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| |
Collapse
|
10
|
Abstract
No specific diagnostic test is available to identify patients with proximal myotonic myopathy and to distinguish them from common disorders causing similar complaints. We describe three patients from three separate families who were initially diagnosed as having hypothyroid myopathy. Proximal weakness, stiffness and myotonia have persisted in each patient (2-10 years) despite the restoration of the euthyroid state. A familial pattern of autosomal dominant inheritance for proximal weakness, myotonia, and cataracts was clearly identified in one family and was likely in the other two families. DNA testing showed normal size of CTG repeat in the gene for myotonic dystrophy. The clinical presentation of these three patients strongly suggests that hypothyroidism can unmask PROMM in asymptomatic individuals who carry the genetic abnormality. Other cases of 'hypothyroid myopathy' may represent examples of unmasked PROMM.
Collapse
Affiliation(s)
- V Sansone
- Department of Neurology, University of Milan, San Donato Hospital, Via Morandi, 30, 20097 San Donato Milanese, Milan, Italy.
| | | | | |
Collapse
|
11
|
Abstract
This article provides a review of some of the muscular disorders that can arise from some of the commonly seen endocrinologic disturbances. Thyroid, parathyroid, and adrenal dysfunctions as they relate to neuromuscular symptoms are discussed. Common clinical presentations of the endocrine myopathies are highlighted, along with diagnostic evaluation and treatments.
Collapse
Affiliation(s)
- H A Horak
- Neurophysiology Fellow, Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | | |
Collapse
|
12
|
Rodolico C, Toscano A, Benvenga S, Mazzeo A, Bartolone S, Bartolone L, Girlanda P, Monici MC, Migliorato A, Trimarchi F, Vita G. Myopathy as the persistently isolated symptomatology of primary autoimmune hypothyroidism. Thyroid 1998; 8:1033-8. [PMID: 9848719 DOI: 10.1089/thy.1998.8.1033] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although disorders of thyroid function may cause a wide range of muscle disturbances, an overt myopathy has been rarely reported as an isolated clinical presentation of hypothyroidism. We observed 10 patients (5 males and 5 females) who had been referred to the department of neurology because of muscular fatigability, myalgia, cramps, or proximal weakness. Laboratory investigation showed that all patients had hypothyroidism due to Hashimoto's thyroiditis (atrophic variant in 9/10). Classic symptoms/signs of hypothyroidism such as lethargy, constipation, cold intolerance, myxedematous facies, and/or bradycardia were absent, as assessed independently by the three coauthoring thyroidologists. Muscular complaints improved greatly and then disappeared after substitutive levothyroxine treatment. Muscle biopsy revealed nonspecific changes. Nicotinamide adenine dinucleotide reductase (NADH-TR)-hyporeactive cores were present in two patients (10% and 90% of type 1 fibers). On electron microscopy, the core areas showed disorganized myofibrils, Z-band streaming, rod formation, and paucity of mitochondria and glycogen granules. Desmin intermediate filaments were overexpressed only in some cores. The similarity of the pattern of desmin expression between hypothyroid cores and target lesions of denervated fibers supports the hypothesis that, at least in some of our patients, myopathy was the result of an impaired nerve-mediated action of thyroid hormones on skeletal muscle. Our observations suggest that an isolated myopathy as the sole manifestation of hypothyroidism is not a rare event. We postulate that our cases may constitute a peculiar subgroup of Hashimoto's thyroiditis patients: (1) the strikingly abnormal F/M ratio of 1:1; (2) the relatively younger age; (3) the rarity of the goitrous variant; (4) the unusual finding of antithyroglobulin (Tg-Ab) > antithyroid peroxidase (TPO-Ab). Thorough evaluation of thyroid function is appropriate in patients with myopathy of uncertain origin.
Collapse
Affiliation(s)
- C Rodolico
- Institute of Neurological and Neurosurgical Sciences, University of Messina, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
The myopathies associated with endocrine disorders range in clinical presentation from the relatively nonspecific pattern of proximal muscle weakness of glucocorticoid excess states to specific presentations of contractions produced in tetany. All endocrine neuromyopathies emphasize the role of skeletal muscle in protein, carbohydrate, and electrolyte metabolism. Hormonal abnormalities tend to compromise muscle force generation by indirect effects on muscle function. The recognition and effective treatment of all these disorders require the identification of the underlying hormonal imbalances and awareness of general medical problems produced by the endocrine disorders.
Collapse
Affiliation(s)
- A Anagnos
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | | |
Collapse
|
14
|
Abstract
Acute compartment syndrome (ACS) is caused by conditions that either decrease the size of the compartment of increase the content of the compartment. Intracompartmental pressures are raised, thereby initiating a sequence of events that results in myoneural injury. Although limb trauma is the most common and well-organized etiology of ACS, the cause is frequently not readily apparent. Thyroid disease is not a commonly recognized cause of ACS; only one case of ACS associated with hypothyroidism has been previously reported. We now describe a second case of ACS in a patient with severe hypothyroidism and discuss the possible pathogenesis of this association.
Collapse
Affiliation(s)
- S I Hsu
- Medical Services, Massachusetts General Hospital, Boston 02114, USA
| | | | | |
Collapse
|
15
|
Lochmüller H, Reimers CD, Fischer P, Heuss D, Müller-Höcker J, Pongratz DE. Exercise-induced myalgia in hypothyroidism. THE CLINICAL INVESTIGATOR 1993; 71:999-1001. [PMID: 8124059 DOI: 10.1007/bf00180031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recurrent rhabdomyolysis is very uncommon in hypothyroid myopathy. A 30-year-old woman is reported, who presented with exercise-induced myalgias and high levels of serum creatine kinase but no muscle weakness. Muscle biopsy showed signs of a recurrent rhabdomyolysis. Hypothyroidism was diagnosed by serum hormone levels. The myopathy rapidly improved with thyroxine treatment.
Collapse
Affiliation(s)
- H Lochmüller
- Friedrich-Baur-Institut bei der Medizinischen und Neurologischen Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München
| | | | | | | | | | | |
Collapse
|
16
|
Drouet A, Valance J. [Hypothyroid hypertrophic myopathy in adults related to chronic lymphocytic thyroiditis. A case]. Rev Med Interne 1993; 14:864-8. [PMID: 8191106 DOI: 10.1016/s0248-8663(05)81146-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The authors report a case of hypothyroid hypertrophic myopathy which reveal chronic lymphocytic thyroiditis. This entity est uncommon, can be the most important sign of hypothyroidism and cure after the institution of thyroid hormone replacement therapy. The E. M. G. is usually myopathic and serum muscle markers (myoglobin and enzymes) increased. Pathologic studies of muscle show caracteritic but non specific and inconstant abnormalities. Hypothyroid myopathy could be caused by a mitochondrial oxidative phosphorylation deficiency or changes in muscle contractile properties (both in fibre type proportion and in the properties of the muscle contractile proteins).
Collapse
Affiliation(s)
- A Drouet
- Service de neurologie, hôpital d'instruction des armées Sainte-Anne, Toulon Naval, France
| | | |
Collapse
|