RESULTS—In hypothyroid patients 79% had neuromuscular complaints, 38% had clinical weakness (manual muscle strength testing) in one or more muscle groups, 42% had signs of sensorimotor axonal neuropathy, and 29% had carpal tunnel syndrome. Serum creatine kinase did not correlate with weakness. Exertional rhabdomyolysis is a condition resulting from skeletal muscle damage and release of intracellular toxins into the systemic circulation as a consequence of extreme physical effort. With increasing numbers of people partaking in high-intensity workouts, we hypothesized that the rate of.
J Neurol Neurosurg Psychiatry. 2000 Jun; 68(6): 750–755.
PMID: 10811699
This article has been cited by other articles in PMC.
Abstract
OBJECTIVES—To evaluateneuromuscular signs and symptoms in patients with newly diagnosedhypothyroidism and hyperthyroidism.
METHODS—A prospectivecohort study was performed in adult patients with newly diagnosedthyroid dysfunction. Patients were evaluated clinically with hand helddynamometry and with electrodiagnosis. The clinical features ofweakness and sensory signs and the biochemical data were evaluatedduring treatment.
RESULTS—In hypothyroidpatients 79% had neuromuscular complaints, 38% had clinical weakness(manual muscle strength testing) in one or more muscle groups, 42% hadsigns of sensorimotor axonal neuropathy, and 29% had carpal tunnelsyndrome. Serum creatine kinase did not correlate with weakness. After1 year of treatment 13% of the patients still had weakness. Inhyperthyroid patients 67% had neuromuscular symptoms, 62% hadclinical weakness in at least one muscle group that correlated with FT4concentrations, but not with serum CK. Nineteen per cent of thepatients had sensory-motor axonal neuropathy and 0% had carpal tunnelsyndrome. The neuromuscular signs developed rapidly, early in thecourse of the disorder and were severe, but resolved rapidly andcompletely during treatment (average time 3.6months).
CONCLUSIONS—Neuromuscularsymptoms and signs were present in most patients. About 40% of thehypothyroid patients and 20% of the hyperthyroid patients hadpredominantly sensory signs of a sensorimotor axonal neuropathy earlyin the course of thyroid disease. Weakness in hyperthyroidism evolvedrapidly at an early stage of the disorder and resolved completelyduring treatment, suggesting a functional muscle disorder. Hand helddynamometry is sensitive for the detection of weakness and for theclinical evaluation of treatment effects. Weakness in hypothyroidism ismore difficult to treat, suggesting myopathy.
METHODS—A prospectivecohort study was performed in adult patients with newly diagnosedthyroid dysfunction. Patients were evaluated clinically with hand helddynamometry and with electrodiagnosis. The clinical features ofweakness and sensory signs and the biochemical data were evaluatedduring treatment.
RESULTS—In hypothyroidpatients 79% had neuromuscular complaints, 38% had clinical weakness(manual muscle strength testing) in one or more muscle groups, 42% hadsigns of sensorimotor axonal neuropathy, and 29% had carpal tunnelsyndrome. Serum creatine kinase did not correlate with weakness. After1 year of treatment 13% of the patients still had weakness. Inhyperthyroid patients 67% had neuromuscular symptoms, 62% hadclinical weakness in at least one muscle group that correlated with FT4concentrations, but not with serum CK. Nineteen per cent of thepatients had sensory-motor axonal neuropathy and 0% had carpal tunnelsyndrome. The neuromuscular signs developed rapidly, early in thecourse of the disorder and were severe, but resolved rapidly andcompletely during treatment (average time 3.6months).
CONCLUSIONS—Neuromuscularsymptoms and signs were present in most patients. About 40% of thehypothyroid patients and 20% of the hyperthyroid patients hadpredominantly sensory signs of a sensorimotor axonal neuropathy earlyin the course of thyroid disease. Weakness in hyperthyroidism evolvedrapidly at an early stage of the disorder and resolved completelyduring treatment, suggesting a functional muscle disorder. Hand helddynamometry is sensitive for the detection of weakness and for theclinical evaluation of treatment effects. Weakness in hypothyroidism ismore difficult to treat, suggesting myopathy.
Full Text
The Full Text of this article is available as a PDF (127K).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Rao SN, Katiyar BC, Nair KR, Misra S. Neuromuscular status in hypothyroidism. Acta Neurol Scand. 1980 Mar;61(3):167–177. [PubMed] [Google Scholar]
- Nemni R, Bottacchi E, Fazio R, Mamoli A, Corbo M, Camerlingo M, Galardi G, Erenbourg L, Canal N. Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases. J Neurol Neurosurg Psychiatry. 1987 Nov;50(11):1454–1460.[PMC free article] [PubMed] [Google Scholar]
- Ramsay ID. Electromyography in thyrotoxicosis. Q J Med. 1965 Jul;34(135):255–267. [PubMed] [Google Scholar]
- Puvanendran K, Cheah JS, Naganathan N, Wong PK. Thyrotoxic myopathy: a clinical and quantitative analytic electromyographic study. J Neurol Sci. 1979 Aug;42(3):441–451. [PubMed] [Google Scholar]
- Berlit P, Mahlberg U, Usadel KH. Zur Frage der Polyneuropathie bei Hyperthyreose--eine klinisch-neurophysiologische Studie. Schweiz Arch Neurol Psychiatr (1985) 1992;143(1):81–90. [PubMed] [Google Scholar]
- Sözay S, Gökçe-Kutsal Y, Celiker R, Erbas T, Başgöze O. Neuroelectrophysiological evaluation of untreated hyperthyroid patients. Thyroidology. 1994 Aug;6(2):55–59. [PubMed] [Google Scholar]
- Khaleeli AA, Gohil K, McPhail G, Round JM, Edwards RH. Muscle morphology and metabolism in hypothyroid myopathy: effects of treatment. J Clin Pathol. 1983 May;36(5):519–526.[PMC free article] [PubMed] [Google Scholar]
- Khaleeli AA, Edwards RH. Effect of treatment on skeletal muscle dysfunction in hypothyroidism. Clin Sci (Lond) 1984 Jan;66(1):63–68. [PubMed] [Google Scholar]
- Da Nóbrega AC, Vaisman M, De Araújo CG. Skeletal muscle function and body composition of patients with hyperthyroidism. Med Sci Sports Exerc. 1997 Feb;29(2):175–180. [PubMed] [Google Scholar]
- Olson BR, Klein I, Benner R, Burdett R, Trzepacz P, Levey GS. Hyperthyroid myopathy and the response to treatment. Thyroid. 1991;1(2):137–141. [PubMed] [Google Scholar]
- Khaleeli AA, Griffith DG, Edwards RH. The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle. Clin Endocrinol (Oxf) 1983 Sep;19(3):365–376. [PubMed] [Google Scholar]
- van der Ploeg RJ, Fidler V, Oosterhuis HJ. Hand-held myometry: reference values. J Neurol Neurosurg Psychiatry. 1991 Mar;54(3):244–247.[PMC free article] [PubMed] [Google Scholar]
- Keating JL, Matyas TA. The influence of subject and test design on dynamometric measurements of extremity muscles. Phys Ther. 1996 Aug;76(8):866–889. [PubMed] [Google Scholar]
- Notermans NC, Wokke JH, Franssen H, van der Graaf Y, Vermeulen M, van den Berg LH, Bär PR, Jennekens FG. Chronic idiopathic polyneuropathy presenting in middle or old age: a clinical and electrophysiological study of 75 patients. J Neurol Neurosurg Psychiatry. 1993 Oct;56(10):1066–1071.[PMC free article] [PubMed] [Google Scholar]
- Franssen H, Wieneke GH. Nerve conduction and temperature: necessary warming time. Muscle Nerve. 1994 Mar;17(3):336–344. [PubMed] [Google Scholar]
- Wilbourn AJ. The electrodiagnostic examination with myopathies. J Clin Neurophysiol. 1993 Apr;10(2):132–148. [PubMed] [Google Scholar]
- Stålberg E, Falck B. The role of electromyography in neurology. Electroencephalogr Clin Neurophysiol. 1997 Dec;103(6):579–598. [PubMed] [Google Scholar]
- Chiappa KH. Transcranial motor evoked potentials. Electromyogr Clin Neurophysiol. 1994 Jan-Feb;34(1):15–21. [PubMed] [Google Scholar]
- Bohannon RW. Manual muscle test scores and dynamometer test scores of knee extension strength. Arch Phys Med Rehabil. 1986 Jun;67(6):390–392. [PubMed] [Google Scholar]
- van der Ploeg RJ, Oosterhuis HJ, Reuvekamp J. Measuring muscle strength. J Neurol. 1984;231(4):200–203. [PubMed] [Google Scholar]
- Donofrio PD, Albers JW. AAEM minimonograph #34: polyneuropathy: classification by nerve conduction studies and electromyography. Muscle Nerve. 1990 Oct;13(10):889–903. [PubMed] [Google Scholar]
- Ozata M, Ozkardes A, Dolu H, Corakçi A, Yardim M, Gundogan MA. Evaluation of central motor conduction in hypothyroid and hyperthyroid patients. J Endocrinol Invest. 1996 Nov;19(10):670–677. [PubMed] [Google Scholar]
- Ono S, Inouye K, Mannen T. Myopathology of hypothyroid myopathy. Some new observations. J Neurol Sci. 1987 Feb;77(2-3):237–248. [PubMed] [Google Scholar]
- Roquer J, Cano JF. Carpal tunnel syndrome and hyperthyroidism. A prospective study. Acta Neurol Scand. 1993 Aug;88(2):149–152. [PubMed] [Google Scholar]
- de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992 Apr;45(4):373–376. [PubMed] [Google Scholar]
Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group