THIONAMIDE-ASSOCIATED NECROTIZING AUTOIMMUNE MYOPATHY (NAM) IN GRAVES’ DISEASE

A CASE REPORT

Authors

  • Yotsapon Thewjitcharoen
  • Waralee Chatchomchuan
  • Sriurai Porramatikul
  • Prakit Anukoolwittaya
  • Rajata Rajatanavin
  • Thep Himathongkam

Keywords:

anti-thyroid drugs (ATDs), Thionamide, Necrotizing Autoimmune Myopathy (NAM), Graves’ disease, Myositis

Abstract

CASE
Necrotizing Autoimmune Myopathy (NAM) has never been reported as a cause of myositis in thionamide-treated Graves’ disease (GD). A 21-year-old Thai female presented with a 12-month history of palpitations. A diagnosis of GD was confirmed by elevated serum anti-TSH receptor antibody. Methimazole (MMI) 20 mg/day was started. Eleven weeks after therapy, she complained of generalized muscle pain. Elevated serum CK level at 791 U/L (<170) was found. MMI was switched to Propylthiouracil (PTU) 450 mg/day but serum CK level further rose to 2,538 U/L with worsening myalgia. Radioactive iodine (RAI) 30 mCi was given and she developed hypothyroidism at 9 weeks after treatment. She unexpectedly developed rhabdomyolysis (peak serum CK level at 13,084 U/L) while having a mild COVID-19 infection at 10 weeks after RAI. Finally, the diagnosis of NAM was established based on muscle biopsy. Our case highlighted NAM as an unusual cause of thionamide-associated myositis.

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Author Biographies

Yotsapon Thewjitcharoen

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Waralee Chatchomchuan

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Sriurai Porramatikul

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok,
Thailand

Prakit Anukoolwittaya

King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Rajata Rajatanavin

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok,
Thailand

Thep Himathongkam

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

References

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Published

2023-11-09

How to Cite

Thewjitcharoen, Y., Chatchomchuan, W. ., Porramatikul, S., Anukoolwittaya, P., Rajatanavin, R., & Himathongkam, T. (2023). THIONAMIDE-ASSOCIATED NECROTIZING AUTOIMMUNE MYOPATHY (NAM) IN GRAVES’ DISEASE: A CASE REPORT. Journal of the ASEAN Federation of Endocrine Societies, 38(S3), 94. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/3487

Issue

Vol. 38 No. S3 (2023): AFES Book of Abstracts (Supplement)

Section

Poster Presentation | Thyroid

License

Copyright (c) 2023 Yotsapon Thewjitcharoen, Waralee Chatchomchuan, Sriurai Porramatikul, Prakit Anukoolwittaya, Rajata Rajatanavin, Thep Himathongkam

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