Hypothyroidism masquerading as polymyositis

Cabili, S; Kaplinsky, N; Pines, A; Frankl, O

doi:10.1136/pgmj.58.683.545

Cited by 13 publications

(11 citation statements)

References 19 publications

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“…12 Coexisting clinical signs and symptoms of hypothyroidism, including delayed relaxation phase of the deep tendon reflexes, a normal electromyogram, and the absence of the characteristic inflammatory changes on muscle biopsy, all help to distinguish hypothyroid myopathy from polymyositis. 10,[12][13][14][15][16][17][18] Electromyographic studies in such patients have yielded normal results in many of the patients and neuromyopathic changes consistent with "nonspecific hypothyroid myopathy" in the others. 6,11,15,19,20 Muscle biopsies were normal in 25% of patients observed, whereas the remaining biopsies have demonstrated varying degrees of type II fiber atrophy, type I fiber hypertrophy, central nuclei deposition, and increased percentage of type I fibers.…”

Section: Effects Of Hypothyroidism On Skeletal Musclementioning

confidence: 90%

Role of Thyroid Disease in the Development of Statin-Induced Myopathy

Rush¹,

Danzi²,

Klein³

2006

The Endocrinologist

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Hypothyroidism is a common endocrine disease, which, in addition to its classic signs and symptoms, can present with primary complaints of myopathy. Myopathy can cause skeletal muscle weakness, tenderness, and pain and is often associated with elevated creatine kinase levels. There are many neuromuscular causes of myopathy, including inflammatory and infectious myopathies, metabolic and hereditary myopathies, and those caused by drugs or toxins. Hypothyroid patients with musculoskeletal symptoms can have elevated serum creatine kinase levels, which clinically resemble polymyositis. However, hypothyroid myopathies can be distinguished from polymyositis by coexisting signs and symptoms of hypothyroidism such as delayed relaxation phase of the deep tendon reflexes and the absence of inflammatory changes on muscle biopsy. The treatment of hypothyroidism with thyroid hormone replacement will alleviate symptoms of myopathy as well as lower the characteristic hyperlipidemia associated with hypothyroidism. Hypercholesterolemia, which can arise from different etiologies, is frequently treated with a class of HMG-CoA reductase inhibitors called statins. One of the most significant risks associated with the use of statins is the development of myopathy, a risk that may be compounded by the coexistence of hypothyroidism. The underlying metabolic mechanisms that account for muscle disease in these 2 settings show some common etiologies. The overlap of symptoms associated with hypothyroidism and statin-induced myopathy should prompt the physician to screen all patients presenting with myopathic symptoms with or without elevated creatine kinase levels and all hyperlipidemic patients before initiating statin therapy for hypothyroidism using a measurement of thyroid-stimulating hormone. (The Endocrinologist 2006;16: 279 -285) Learning Objectives• Describe the characteristics of the myopathy sometimes associated with hypothyroidism as well as the relationship between the hypothyroid state and hyperlipidemia. • Identify the key features of statin-induced myopathy.• Outline the ways in which hypothyroidism, statin treatment, and myopathy relate to one another, and the clinical implications of these associations.

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Section: Effects Of Hypothyroidism On Skeletal Musclementioning

confidence: 90%

Role of Thyroid Disease in the Development of Statin-Induced Myopathy

Rush¹,

Danzi²,

Klein³

2006

The Endocrinologist

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“…Patients with hypothyroidism may present rheumatic complaints due to chronic joint effusions (Bland & Frymoyer, 1970), muscular pains (Wilke et al, 1981) or proximal muscle weakness (Cabili et al, 1982). We report a patient who suffered from a painful destructive arthropathy affecting the proximal interphalangeal (PIP) joints of the fingers.…”

Section: Introductionmentioning

confidence: 93%

Hypothyroidism presenting as destructive arthropathy of the fingers

Gerster

Quadri

Saudan³

1985

Postgraduate Medical Journal

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Summary:A patient presenting with destructive arthropathy of the proximal interphalangeal (PIP) joints of the hands is described. She was initially believed to have rheumatoid arthritis but non-steroidal anti-inflammatory drugs were of no help. The patient was subsequently found to have hypothyroidism and erosive osteoarthritis of the fingers. Joint swelling, pain and stiffness responded dramatically to thyroid hormone substitution. The PIP joint spaces reappeared on the radiographs within 9 months.This case suggest that hypothyroidism may induce destructive arthropathy of the finger joints. As thyroxine replacement may reverse the rheumatic complaints, hypothyroidism should be considered in the differential diagnosis of a destructive arthropathy of unclear aetiology.

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“…The elevation in serum creatine kinase in patients with hypothyroidism is also due to subnormal body temperature causing enhancement in the permeability of the muscle cell leading to increased leakage of the enzyme from the muscle cells. 2,3,4 Thus long standing hypothyroidism causes significant reversible changes in renal function and muscular function which if left undetected and untreated may result in renal failure and myopathies. The aims of this study were to compare parameters of serum creatinine, creatinine clearance and serum creatine kinase in overt hypothyroid cases.…”

Section: Introductionmentioning

confidence: 99%

Renal and Muscular Dysfunction in Overt Hypothyroidism

Imtiaz¹,

Sushith²,

Prathima³

et al. 2015

jebmh

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BACKGROUND: There is a significant alteration in creatine kinase, creatinine, creatinine clearance and estimated GFR(eGFR) in hypothyroid patients which may be due to renal and muscular damage resulting in renal failure and myopathies. Our study adds to the existing knowledge, the importance of periodic assessment of renal parameters and creatine kinase in hypothyroid patients. AIM: The aims of this study were to compare parameters of serum creatinine, creatinine clearance, eGFR and serum creatine kinase in patient with overt hypothyroidism. MATERIALS AND METHODS: This Case control study included twenty eight diagnosed cases of hypothyroidism in the department group 15-75 years. Based on T3,T4, TSH levels, subjects were diagnosed as overt hypothyroids. Results were compared with age and sex matched twenty five euthyroids. Serum T3, T4 and TSH; Serum creatinine; Creatinine clearance; and Serum creatine kinase were estimated and analysed. RESULTS:The results of the present study were obtained from 53 subjects out of whom 25 were controls and 28 were overt hypothyroids. Age distribution of study subjects shows that the mean age was 36.30±8.30 for overt hypothyroids. Sex distribution of study subjects shows that majority of overt hypothyroids (78.6%) were females. Pairwise comparison of T3, T4 and TSH among euthyroids and overt hypothyroid groups showed that the mean difference of 41.388 between controls and overt hypothyroids. Overt hypothyroids had low T3 and T4 levels with high TSH levels. Comparison of mean of creatinine clearance in the study groups shows that the mean in controls, and overt hypothyroids were 96.97±31.90 ml/min/1.73 m 2 , and 79.95±25.51 ml/min/1.73 m 2 respectively. The mean of creatinine in the study and control groups were respectively 1.00±0.26 mg/dl and 0.86±0.22 mg/dl. The mean of creatine kinase in the study and control groups were 231(486) IU/L and 94(±22.5) IU/L respectively. The mean of eGFR in the study and control subjects were 70.14±22.55 ml/min/1.73 m 2 and 85.88±30.24 ml/min/1.73 m 2 . CONCLUSION: our study shows that patients with hypothyroidism can gradually end up with renal dysfunction and myopathies. This can be prevented by monitoring thyroid hormones levels along with periodic assessment of renal parameters(creatinine and creatinine clearance) and creatine kinase in hypothyroid patients. This may beneficial in reducing the morbidity of patients. HOW TO CITE THIS ARTICLE:

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Hypothyroidism masquerading as polymyositis

Cited by 13 publications

References 19 publications

Role of Thyroid Disease in the Development of Statin-Induced Myopathy

Role of Thyroid Disease in the Development of Statin-Induced Myopathy

Hypothyroidism presenting as destructive arthropathy of the fingers

Renal and Muscular Dysfunction in Overt Hypothyroidism

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