Neuromuscular Dysfunction and Electrophysiological Findings in Patients With Hypothyroidism and Hyperthyroidism

Electrophysiological Findings in Thyroid Disease


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Authors

  • Arzu Akgül Etlik City Hospital, Department of Nephrology, Ankara, Turkey https://orcid.org/0009-0007-8119-3893
  • Lale Akbulut Aktekin Private Clinic, Ankara, Turkey
  • Erdal Eskioğlu Mamak Su Medical Center, Ankara, Turkey

DOI:

https://doi.org/10.5281/zenodo.10635564

Keywords:

Hypothyroidism, hyperthyroidism, neuromuscular

Abstract

Background: We aimed to determine the frequency of neuropathy and myopathy in newly diagnosed hypothyroid and hyperthyroid patients and to investigate the correlation between serum creatine kinase (CK) concentration and thyroid dysfunction.

Methods: A total of 21 hyperthyroid, 19 hypothyroid, and 20 healthy control subjects were selected for the study. All participants underwent neuromuscular examinations for paresthesia, diffuse pain, muscle cramps, and muscle weakness. Electroneurophysiologic studies were performed on all participants.

Results: Neuromuscular complaints were observed more frequently in the hypothyroid and hyperthyroid groups compared to the control group. Myopathy was detected in 10% of the hypothyroid group and 4% of the hyperthyroid group. Polyphasia potential abnormality was detected in 21% of the hypothyroid group and 14% of the hyperthyroid group. CK elevation was found in 42% of patients in the hypothyroid group and 4% of patients in the hyperthyroid group. There was no correlation between symptoms and CK elevation or between myopathy and thyroid function levels. In the electroneurophysiologic study, 14% neuropathy was found in the hyperthyroidism group and 26% in the hypothyroidism group. In the hypothyroid group, polyneuropathy was found in 10%, and carpal tunnel syndrome was found in 10%. Absence of sensory action potential was found in 10% of the hyperthyroid group and 4% of the hypothyroid group, and low compound muscle action potential was found in 4% of the hyperthyroid group. There was no correlation between thyroid hormone levels and neuropathy.

Conclusion: Neuromuscular complaints and neuropathic findings are highly prevalent in patients with thyroid dysfunction. Neuromuscular symptoms may improve after treatment of thyroid disease. In future studies, comparing post-treatment electrophysiologic values with pre-treatment values and clinical values may more clearly demonstrate the effect of thyroid function on the neuromuscular system.

Keywords: Hypothyroidism, hyperthyroidism, neuromuscular

References

Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Jul 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK500006/

Örük GG., Bahçeci M. Tiroid ve paratiroid hastalıklarında nöromuskuler sistem bulguları. Pam Tıp Derg. 2013, 6(2):108-117.

Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry. 2000;68(6):750-755. doi:10.1136/jnnp.68.6.750

Kececi H, Degirmenci Y. Hormone replacement therapy in hypothyroidism and nerve conduction study. Neurophysiol Clin. 2006;36(2):79-83. doi:10.1016/j.neucli.2006.04.001

Eslamian F, Bahrami A, Aghamohammadzadeh N, Niafar M, Salekzamani Y, Behkamrad K. Electrophysiologic changes in patients with untreated primary hypothyroidism. J Clin Neurophysiol. 2011;28(3):323-328. doi:10.1097/WNP.0b013e31821c30d9

Kumar N, Gadpayle AK, Roshan S. Thyrotoxic myo-neuropathy. J Indian Acad Clin Med. 13(3):255-6, 2012.

Papanikolaou N, Perros P. An unusual presenting symptom of graves’ disease: myalgia. Eur Thyroid J. 2013;1(4):274-276. doi:10.1159/000343826

Cakir M, Samanci N, Balci N, Balci MK. Musculoskeletal manifestations in patients with thyroid disease. Clin Endocrinol (Oxf). 2003;59(2):162-167. doi:10.1046/j.1365-2265.2003.01786.x

Sözay S, Gökçe-Kutsal Y, Celiker R, Erbas T, Başgöze O. Neuroelectrophysiological evaluation of untreated hyperthyroid patients. Thyroidology. 1994 Aug;6(2):55-9.

El-Salem K, Ammari F. Neurophysiological changes in neurologically asymptomatic hypothyroid patients: a prospective cohort study. J Clin Neurophysiol. 2006;23(6):568-572. doi:10.1097/01.wnp.0000231273.22681.0e

Madhu SV, Jain R, Kant S, Prakash V, Kumar V. Myopathy presenting as a sole manifestation of hypothyroidism. J Assoc Physicians India. 2010;58:569-570.

Klein I, Levey GS. Thyroid myopathy. Thyroid Today. 1983;6:1–6.13

Kushnir M, Klein C, Kimiagar Y, Pollak L, Rabey JM. Medial dorsal superficial peroneal nerve studies in patients with polyneuropathy and normal sural responses. Muscle Nerve. 2005;31(3):386-389. doi:10.1002/mus.20183

Donofrio PD, Albers JW. AAEM minimonograph #34: polyneuropathy: classification by nerve conduction studies and electromyography. Muscle Nerve. 1990;13(10):889-903. doi:10.1002/mus.880131002

Khedr EM, El Toony LF, Tarkhan MN, Abdella G. Peripheral and central nervous system alterations in hypothyroidism: electrophysiological findings. Neuropsychobiology. 2000;41(2):88-94. doi:10.1159/00002663820

Gupta N, Arora M, Sharma R, Arora KS. Peripheral and Central Nervous System Involvement in Recently Diagnosed Cases of Hypothyroidism: An Electrophysiological Study. Ann Med Health Sci Res. 2016;6(5):261-266. doi:10.4103/amhsr.amhsr_39_1621

Rao SN, Katiyar BC, Nair KR, Misra S. Neuromuscular status in hypothyroidism. Acta Neurol Scand. 1980;61(3):167-177. doi:10.1111/j.1600-0404.1980.tb01479.x

Kececi H, Degirmenci Y. Hormone replacement therapy in hypothyroidism and nerve conduction study. Neurophysiol Clin. 2006;36(2):79-83. doi:10.1016/j.neucli.2006.04.001

Nemni R, Bottacchi E, Fazio R, et al. Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases. J Neurol Neurosurg Psychiatry. 1987;50(11):1454-1460. doi:10.1136/jnnp.50.11.1454

Berlit P., Mahlberg U., Usadel KH. Polyneuropathy in hyperthyroidism-a clinical neurophysiologic study. Schweiz Arch Neurol Psychiatr.1992;143(1):81-90.

Suresh E, Morris IM. How valuable is screening for thyroid disease in patients with carpal tunnel syndrome?. J Clin Rheumatol. 2004;10(3):116-118. doi:10.1097/01.rhu.0000130859.10006.27

van Dijk MA, Reitsma JB, Fischer JC, Sanders GT. Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review. Clin Chem. 2003;49(9):1437-1444. doi:10.1373/49.9.1437

de Rijk MC, Vermeij FH, Suntjens M, van Doorn PA. Does a carpal tunnel syndrome predict an underlying disease?. J Neurol Neurosurg Psychiatry. 2007;78(6):635-637. doi:10.1136/jnnp.2006.102145

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;19(3):365-376. doi:10.1111/j.1365-2265.1983.tb00010.x

Finsterer J, Stöllberger C, Grossegger C, Kroiss A. Hypothyroid myopathy with unusually high serum creatine kinase values. Horm Res. 1999;52(4):205-208. doi:10.1159/000023462

Klein I, Ojamaa K. Thyroid (neuro)myopathy. Lancet. 2000;356(9230):614. doi:10.1016/s0140-6736(00)02601-5

Vold PL, Weiss PJ. Rhabdomyolysis from tourniquet trauma in a patient with hypothyroidism. West J Med. 1995;162(3):270-271.

Beyer IW, Karmali R, Demeester-Mirkine N, Cogan E, Fuss MJ. Serum creatine kinase levels in overt and subclinical hypothyroidism. Thyroid. 1998;8(11):1029-1031. doi:10.1089/thy.1998.8.1029

Brzozowska MM, Banthia S, Thompson S, Narasimhan M, Lee J. Severe Hypothyroidism Complicated by Myopathy and Neuropathy with Atypical Demyelinating Features. Case Rep Endocrinol. 2021;2021:5525156. Published 2021 May 19. doi:10.1155/2021/5525156

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Published

2024-02-14

How to Cite

Akgül, A., Akbulut Aktekin, L., & Eskioğlu, E. (2024). Neuromuscular Dysfunction and Electrophysiological Findings in Patients With Hypothyroidism and Hyperthyroidism: Electrophysiological Findings in Thyroid Disease. Journal of European Internal Medicine Professionals, 2(1). https://doi.org/10.5281/zenodo.10635564

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