Myopathy: As an Initial Presentation of Hypothyroidism in Two cases of Autoimmune Thyroiditis

Anup Kumar Saha,Kak Azad,Md Abul Kalam Azad,Md Azizul Islam,Md Shamsul Haque,Shaheen Lipika Quayum,Tofayel Ahmed

doi:10.3329/jom.v8i1.1379

Abstract

Although hypothyroidism may cause a wide range of muscle disturbances, an overt myopathy may rarely present as an isolated initial presentation of hypothyroidism. The frequency of myopathy in hypothyroidism ranges from 30 to 80%. The major muscular symptoms are weakness, muscular cramps and myalgia. Laboratorial investigation generally shows increased levels of muscle enzymes and low serum thyroid hormones, with high thyrotrophic-stimulating hormone (TSH) elevated. The electrophysiological study reveals myopathy, neuropathy or mixed pattern. The treatment consists in hormone replacement and the prognosis is good in most of the cases. We report two cases that developed cramps, myalgia, and weakness, one of them presented as a polymyositis-like syndrome. The muscle enzymes were increased with a raised level of TSH. The myopathy was the initial manifestation of hypothyroidism in these cases. Both the patient was treated by replacement of thyroxin with significant clinical and biochemical improvement. DOI = 10.3329/jom.v8i1.1379 J MEDICINE 2007; 8 : 32-36

Highlights

The thyroid hormone is necessary to cell metabolism of all organic systems
Thyroid myopathy is responsible for 5% of acquired myopathies, and an overt myopathy has been rarely reported as an isolated clinical presentation of hypothyroidism[1,2]
We present two cases of Hashimoto’s thyroiditis, where myopathy was the initial presentation, one of which was presented with polymyositis -like syndrome and other was presented as a case of classic myopathy

Summary

Introduction

The thyroid hormone is necessary to cell metabolism of all organic systems. Its deficiency is manifested by a wide range of systemic manifestations with insidious onset[1].Thyroid dysfunction may cause a wide range of muscle disturbances. Case report 1: A young lady aged 27 years, mother of one child presented on 03/03/07 with progressive myalgia and tingling in both hand for four months She had no history of fever, fatigue, arthralgia, arthritis, or weight gain. As her all other antibodies, except ANA was negative, muscle biopsy was not done Since her clinical condition and biochemical profile (Table 1) responded well to thyroid replacement therapy and she was diagnosed as possible polymyositis-like syndrome associated with hypothyroidism due to Hashimoto’s thyroiditis, where painful myopathy was the only initial clinical manifestation. She was assessed and followed up for raised ANA.

No risk

Findings

Discussion