methimazole and Muscle-Weakness

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Drug Therapy, Combination; Electrocardiography; Graves Disease; Humans; Hypokalemia; Male; Methimazole; Muscle Weakness; Propranolol; Tachycardia; Thyroidectomy

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Humans; Hyperthyroidism; Hypokalemia; Hypophosphatemia; Lower Extremity; Male; Methimazole; Muscle Weakness; Propranolol; Young Adult

Thyrotoxic periodic paralysis is an acute endocrine emergency characterized by hyperthyroidism, profound muscle weakness and/or paralysis, and hypokalemia that is not due to potassium deficiency. Typically described in young males of Asian descent, it is becoming increasingly recognized outside of this demographic group and is believed to be an underrecognized cause of symptomatic hypokalemia. Thyrotoxic periodic paralysis usually manifests as acute onset of symmetrical distal extremity weakness and is treated with careful potassium replacement and nonselective β-blockers. In this case, a 43-year-old African American woman with thyrotoxic periodic paralysis had recurrent lower extremity myopathy and acute respiratory failure precipitated by noncompliance with treatment for Graves disease.

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Black or African American; Female; Graves Disease; Humans; Hyperthyroidism; Hypokalemia; Methimazole; Muscle Weakness; Paralysis; Potassium; Propranolol; Respiratory Insufficiency

A 26-year-old Hispanic man with no significant medical history presented to our emergency room with gradual onset weakness of his lower extremities. He was haemodynamically stable and examination revealed loss of motor function in his lower limbs up to the level of hips. Laboratory data revealed hypokalaemia. The patient was started on potassium supplementation and he recovered his muscle strength. Differential diagnosis included familial hypokalaemic periodic paralysis and thyrotoxic periodic paralysis (TPP). Further investigations revealed a low thyroid-stimulating hormone and high free thyroxine levels. Radio iodine 123 scan revealed an enhanced homogeneous uptake in the thyroid suggesting Graves' disease. Thyroid stimulating antibodies were also found to be elevated. The patient was started on methimazole and propranolol and he never had another attack of TPP even at 1 year follow-up.

Topics: Adult; Diagnosis, Differential; Graves Disease; Hispanic or Latino; Humans; Hypokalemia; Hypokalemic Periodic Paralysis; Immunoglobulins, Thyroid-Stimulating; Iodine Radioisotopes; Male; Methimazole; Muscle Strength; Muscle Weakness; Potassium; Propranolol; Thyroid Gland; Thyrotoxicosis; Thyrotropin; Thyroxine

Myopathy is a known complication of hypothyroidism, commonly characterized by an elevation in Creatine Kinase (CPK) due to increase capillary permeability proportional to the hypothyroid state. Thyroid hormone is important for the expression of fast myofibrillar proteins in the muscle. In hypothyroidism the expression of these proteins are deficient and there is an increase accumulation of slow myofibrillar proteins. A rapid or abrupt descend in thyroid hormones caused by radioiodine therapy after prolonged hyperthyroidism can lead to local hypothyroid state within the muscle tissue, resulting in CPK elevation and hypothyroid myopathy. Hormone replacement leads to resolution of symptoms and normalization of muscle enzymes serum levels.

Topics: Diagnosis, Differential; Edema; Electromyography; Emergencies; Female; Graves Disease; Hormone Replacement Therapy; Humans; Hyperthyroidism; Hypothyroidism; Iodine Radioisotopes; Magnetic Resonance Imaging; Methimazole; Muscle Cramp; Muscle Weakness; Propranolol; Reflex, Abnormal; Thyroid Hormones; Thyroxine; Young Adult

Topics: Abdominal Pain; Adrenergic beta-Antagonists; Aged; Antithyroid Agents; Bisoprolol; Female; Humans; Methimazole; Muscle Weakness; Thyroid Crisis

Topics: Adult; Anti-Arrhythmia Agents; Antithyroid Agents; Anxiety; Arrhythmias, Cardiac; Dyspnea; Graves Disease; Humans; Hypokalemic Periodic Paralysis; Malaysia; Male; Methimazole; Muscle Weakness; Neurologic Examination; Potassium; Propranolol; Propylthiouracil; Sleep Initiation and Maintenance Disorders; Tremor; Weight Loss

A 41-year-old man with progressive limb weakness manifested fluctuating muscle weakness as seen in myasthenia gravis (MG). Laboratory investigations revealed hyperthyroidism without the complication of MG. Electrophysiological studies demonstrated abnormal features of neuromuscular transmissions resembling those of the Lambert-Eaton myasthenic syndrome rather than those of MG. A CT scan showed a mediastinal mass that suggested thymic hyperplasia which often complicates MG or hyperthyroidism. Medical treatment of hyperthyroidism resulted in resolution of MG-like symptoms and regression of thymic hyperplasia on CT concomitant with normalization of thyroid function. This case highlights the fact that careful investigations are needed to differentiate MG-like symptoms from genuine MG in cases of hyperthyroidism with thymic lesions.

Topics: Adult; Antithyroid Agents; Diagnosis, Differential; Graves Disease; Humans; Male; Methimazole; Muscle Weakness; Myasthenia Gravis; Thymus Hyperplasia; Thyrotoxicosis

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Anxiety; Body Temperature Regulation; Diagnosis, Differential; Graves Disease; Humans; Hyperthyroidism; Male; Methimazole; Middle Aged; Muscle Weakness; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Tachycardia; Thyroid Function Tests; Tremor; Weight Loss

Topics: Adult; Antithyroid Agents; Graves Disease; Humans; Knee; Male; Methimazole; Muscle Weakness; Paraplegia; Thyroid Function Tests

Hyperthyroidism is the most common disorder of the thyroid. Patients typically present with complaints consistent with a hypermetabolic state, including nervousness, weight loss, heat intolerance, palpitations, irritability, and tremor. This case report reviews a 34-year-old woman who presented with unilateral upper extremity weakness, weight gain, and an episode of atrial fibrillation, the latter coinciding with a 36-hour lack of sleep and excess alcohol and caffeine intake. Although an extensive neurologic evaluation failed to identify any abnormality, the patient's laboratory analysis revealed elevations in thyroxine (T4) and triiodothyronine (T3) levels with unsuppressed thyroid-stimulating hormone levels. Subsequent treatment with the antithyroid drug methimazole (Tapazole) provided complete relief of symptoms. This case report illustrates how health care providers can be diverted to pursue a neurologic etiology when muscle weakness presents as a unilateral symptom. Plausible alternative causes for muscle weakness and other symptoms are presented.

Topics: Adult; Antithyroid Agents; Diagnosis, Differential; Female; Humans; Hyperthyroidism; Methimazole; Muscle Weakness; Nursing Assessment