Onset of hypothyroidism with polymyositis-like clinical features in elderly patients

A. Toscano, S. Bartolone, C. Rodolico, A. Migliorato, V. Macaione, D. La Rosa, S. Benvenga, N. Frisina, G. Vita

Research output: Contribution to journalArticle

Abstract

Impaired muscle function may be a predominant aspect of hypothyroidism and is virtually present in all patients with overt thyroid failure. Less common is the onset of hypothyroidism with clinical features mimicking a polymyositis. We have observed 3 patients, whose age ranged 63-68 years, presenting with muscle aches, cramps, proximal weakness and stiffness. Two patients had dysphagia. Serum creatine kinase (CK) and electromyography (EMG) were altered in two patients. Muscle biopsy showed type II atrophy, sporadic type I and type II grouping, "core-like" areas, and some myopathic changes such as central nuclei and muscle necrosis. No inflammatory changes were present. Immunohistochemistry of several muscle cytoskeletal proteins revealed increased desmin in "core-like" areas. Detection of serum thyroid hormone levels revealed very low triiodo-L-thyronine (T3) and thyroxine (T4), whereas thyroid-stimulating hormone (TSH) was greatly increased as well as serum anti-thyroglobulin, anti-peroxidase and anti-microsome antibodies. The patients were diagnosed having a hypothyroid myopathy due to Hashimoto thyroiditis. L-thyroxine treatment normalized clinical and hormone levels, but serum antibodies remained elevated. Muscle biopsy was fundamental to establish the correct diagnosis in our patients. Presence of overexpression of desmin in cores, as described in target lesions in neurogenic diseases, may suggest a nerve-mediated pathogenesis of hypothyroid myopathy.

Original languageEnglish
Pages (from-to)573-576
Number of pages4
JournalArchives of Gerontology and Geriatrics
Volume22
Issue numberSUPPL.1
Publication statusPublished - 1996

Keywords

  • Desmin
  • L-thyroxin
  • Late-onset hypothyroid myopathy
  • Muscle biopsy
  • Polymyositis

ASJC Scopus subject areas

  • Ageing
  • Medicine(all)

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    Toscano, A., Bartolone, S., Rodolico, C., Migliorato, A., Macaione, V., La Rosa, D., Benvenga, S., Frisina, N., & Vita, G. (1996). Onset of hypothyroidism with polymyositis-like clinical features in elderly patients. Archives of Gerontology and Geriatrics, 22(SUPPL.1), 573-576.