Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study
Ruurd F Duyffa, Joan Van den Boschc, D Martin Lamanb, Bert-Jan Potter van Loonc, Wim H J P Linssena
a Department of
Neurology, St Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE
Amsterdam, The Netherlands, b Department of Clinical Neurophysiology, c Department of Internal Medicine
Correspondence to: Dr WHJP Linssen Wim.Linssen{at}tip.nl
Received 6 September 1999 and in revised form 24 January 2000;
Accepted 26 January 2000
OBJECTIVES
To evaluate
neuromuscular signs and symptoms in patients with newly diagnosed
hypothyroidism and hyperthyroidism.
METHODSA prospective
cohort study was performed in adult patients with newly diagnosed
thyroid dysfunction. Patients were evaluated clinically with hand held
dynamometry and with electrodiagnosis. The clinical features of
weakness and sensory signs and the biochemical data were evaluated
during treatment.
RESULTSIn 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. After
1 year of treatment 13% of the patients still had weakness. In
hyperthyroid patients 67% had neuromuscular symptoms, 62% had
clinical weakness in at least one muscle group that correlated with FT4
concentrations, but not with serum CK. Nineteen per cent of the
patients had sensory-motor axonal neuropathy and 0% had carpal tunnel
syndrome. The neuromuscular signs developed rapidly, early in the
course of the disorder and were severe, but resolved rapidly and
completely during treatment (average time 3.6 months).
CONCLUSIONSNeuromuscular
symptoms and signs were present in most patients. About 40% of the
hypothyroid patients and 20% of the hyperthyroid patients had
predominantly sensory signs of a sensorimotor axonal neuropathy early
in the course of thyroid disease. Weakness in hyperthyroidism evolved
rapidly at an early stage of the disorder and resolved completely
during treatment, suggesting a functional muscle disorder. Hand held
dynamometry is sensitive for the detection of weakness and for the
clinical evaluation of treatment effects. Weakness in hypothyroidism is
more difficult to treat, suggesting myopathy.
Keywords: hypothyroidism; hyperthyroidism; myopathy; neuropathy; dynamometry
© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
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