Hypothyroidism Presenting as a Polymyositis-Like Syndrome (Case Report)
Journal Title: Journal of Neurological Sciences-Turkish - Year 2007, Vol 24, Issue 3
Abstract
Polymyositis-like Syndrome associated with hypothyroidism is a clinical condition characterized by proximal muscle weakness and an elevation of muscle enyzymes. Hypothyroid patients with weakness, cramps and muscle stiffness together with high creatine kinase (CK) levels are usually mis-diagnosed as polymyositis. In these patients the shoulder and pelvic muscles are affected and electrophysiologically non-spesific myopathic changes are seen in half of the patients with normal electrophysiologic studies in the other half. Histopathologically the two syndromes have similar findings; polymyositis and hypothyroidism associated polymyositis syndrome. A clinical response to L-thyroxine is the main clue for diagnosis. We present a 32 year old male patient with proximal muscle weakness and myalgia. He was healthy until 3 months ago when he started to have pain proximally in his lower extremities. He also had problems climbing stairs and raising his arms above his head. His pain got worse and upon admission due to his high CK level (4328U/L) he was diagnosed with polymyositis. There was proximal muscle weakness of the lower extremities on his neurological examination and he had a normal EMG study. His biochemical studies displayed hypothyroidism with a high TSH (203IU/ml) and low FT3 (0,206pg/ml) and FT4 (0,05ng/dl) levels. He also had an elevated anti-TPO (378IU/ml) and his thyroid ultrasonography was compatible with thyroiditis. His muscle biopsy displayed chronic myopathy findings with no inflammation. Since his clinical condition and biochemical profile responded well to thyroid replacement therapy and he was diagnosed as possible polymyositis-like syndrome associated with hypothyroidism.
Authors and Affiliations
Gulbun YUKSEL, Ayse AKPINAR, Nuriye COMEZ, Cihat ORKEN, Hulya TIRELİ
Keywords
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