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Fu SE, Wang RM, Liang XH, Xian J, Pan J, Chen XL, Qiu CC, Tang ZP, Qin YF, Yang HY, Huang LL, Kuang YQ, Ma Y, Luo ZJ. Ultrasound measurement of vastus lateralis and vastus medialis muscle parameters to identify chronic thyrotoxic myopathy. Endocr Connect 2023; 12:e230083. [PMID: 37682119 PMCID: PMC10563633 DOI: 10.1530/ec-23-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/08/2023] [Indexed: 09/09/2023]
Abstract
Introduction Chronic thyrotoxic myopathy (CTM) is a common, easily neglected complication of hyperthyroidism. There are currently no standard diagnostic criteria for CTM, and the ultrasonic characteristics of CTM-affected skeletal muscle remain unclear. Herein, we aimed to evaluate hyperthyroid patients for CTM by ultrasound and identify ultrasonic muscle parameter cutoffs for CTM diagnosis. Materials and methods Each participant underwent ultrasonography. The original (muscle thickness (MT), pennation angle (PA), and cross-sectional area (CSA)) and corrected (MT/height (HT), MT/body mass index (BMI), CSA/HT, and CSA/BMI) parameters of the vastus lateralis and vastus medialis (VM) were evaluated. The diagnostic effectiveness of ultrasound for predicting CTM was determined using receiver operating characteristic (ROC) curve analysis. Our study included 203 participants: 67 CTM patients (18 males, 49 females), 67 non-CTM patients (28 males, 39 females) and 69 healthy controls (20 males, 49 females). Results The CTM group had lower muscular ultrasonic and anthropometric parameters, higher thyroid hormone and thyroid-stimulating hormone receptor antibody (TRAb) levels, and a longer duration of hyperthyroidism than the non-CTM group (P < 0.05). The VM-PA, VM-CSA, VM-CSA/HT, and VM-CSA/BMI were lower in females than in males (P < 0.05). Free thyroxine (FT4) and TRAb both showed significant negative correlations with VM-MT, VM-MT/HT, VM-CSA, and VM-CSA/HT (P < 0.05). VM-MT/BMI and VM-CSA/HT, respectively, best predicted male and female CTM (AUC = 0.84, 0.85; cutoff ≤ 0.07, < 4.01). Conclusion Ultrasound measurement of muscular parameters, especially in the VM, is a valid and feasible way of diagnosing and characterizing possible CTM in hyperthyroidism.
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Affiliation(s)
- Shi-en Fu
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rou-mei Wang
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xing-huan Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Xian
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Pan
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xue-lan Chen
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cheng-cheng Qiu
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhi-ping Tang
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ying-fen Qin
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hai-yan Yang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li-li Huang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Endocrinology, The Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Ya-qi Kuang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Ma
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zuo-jie Luo
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Seife Hassen S, Salih Ali M, Khan A, Mohammed AM, Altermanini M, Al Mohanadi DHSH, Zahid M. Recurrent thyrotoxic periodic paralysis with normokalemia in a 36-year-old man: A case report. Clin Case Rep 2021; 9:e04849. [PMID: 34584714 PMCID: PMC8457415 DOI: 10.1002/ccr3.4849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/11/2021] [Accepted: 08/29/2021] [Indexed: 12/29/2022] Open
Abstract
Among patients with thyrotoxicosis and proximal muscle weakness, some patients with TPP may present with apparent normokalemia in whom a careful administration of potassium may lead to rapid reversal of muscle weakness.
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Affiliation(s)
- Sara Seife Hassen
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Mohamed Salih Ali
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Adeel Khan
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Areej Marwan Mohammed
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Mohamed Altermanini
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | | | - Mohamed Zahid
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
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Kitahara S, Tonouchi T, Otsu Y, Kawachi I, Oyake M, Fujita N. [A case of thyrotoxic myopathy with generalized body muscular atrophy including the tongue muscle, lacking physical manifestations of Basedow disease]. Rinsho Shinkeigaku 2020; 60:677-681. [PMID: 32893239 DOI: 10.5692/clinicalneurol.cn-001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a 74-year-old man with a 2-year history of proximal limb pain, body weight loss of 15 kg, and muscle weakness. Muscle atrophy was evident in the limbs and trunk, as well as the tongue. He was admitted to our hospital with suspected amyotrophic lateral sclerosis (ALS). Although he had no physical manifestations of Basedow disease such as palpitations, hyperhidrosis, hand tremor, exophthalmos, and an enlarged thyroid, he was diagnosed as having thyrotoxic myopathy as laboratory examinations indicated hyperthyroidism and positivity for TSH receptor antibody. The serum level of soluble IL-2 receptor was also elevated. Despite the severe muscle atrophy, the serum CK level was normal. A biopsy from the left quadriceps muscle revealed Type 1 fibers atrophy. Administration of anti-thyroid drugs normalized his thyroid function and the level of soluble IL-2 receptor, leading to improvement of the generalized muscle atrophy.
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Affiliation(s)
- Sho Kitahara
- Department of Neurology, Nagaoka Red Cross Hospital
| | | | - Yutaka Otsu
- Department of Neurology, Nagaoka Red Cross Hospital
| | - Izumi Kawachi
- Department of Neurology, Niigata University Medical and Dental Hospital
| | - Mutsuo Oyake
- Department of Neurology, Nagaoka Red Cross Hospital
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