Thyroid Storm with Acute Flaccid Quadriparesis due to Thyrotoxic Myopathy
A Case Report
Thyrotoxicosis is a well-recognized cause of myopathy, but rarely presents as acute flaccid quadriparesis. We report a 25-year-old female with underlying uncontrolled Graves’ disease who presented with thyroid storm and acute flaccid quadriparesis due to thyrotoxic myopathy. She showed marked clinical improvement with subsequent normalization of her thyroid parameters. Besides highlighting this rare association, this report underscores the importance of considering thyrotoxic myopathy in the evaluation of patients with acute flaccid quadriparesis.
Boddu NJ, Badireddi S, Straub KD, Schwankhaus J, Jagana R. Acute thyrotoxic bulbar myopathy with encephalopathic behaviour: An uncommon complication of hyperthyroidism. Case Rep Endocrinol. 2013;2013:369807. https://www.ncbi.nlm.nih.gov/pubmed/23840978. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690644. https://doi.org/10.1155/2013/369807.
Virameteekul S, Charoensri S, Sawanyawisuth K, Tiamkao S. Concurrence of Myasthenia Gravis and Thyroid Disorders: A Retrospective Database Study. J ASEAN Fed Endocr Soc. 2019;34(2):153-7. https://doi.org/10.15605/jafes.034.02.05.
Riggs JE, Pandey HK, Schochet SS Jr. Critical illness myopathy associated with hyperthyroidism. Mil Med. 2004;169(1):71-2. https://www.ncbi.nlm.nih.gov/pubmed/14964506. https://doi.org/10.7205/milmed.169.1.71.
Brennan MD, Powell C, Kaufman KR, Sun PC, Bahn RS, Nair KS. The impact of overt and subclinical hyperthyroidism on skeletal muscle. Thyroid. 2006;16(4):375–80. https://www.ncbi.nlm.nih.gov/pubmed/16646684. https://doi.org/10.1089/thy.2006.16.375.
Brown WF, Bolton CF, Aminoff MJ. Neuromuscular function and disease: Basic, clinical, and electrodiagnostic aspects. Philadelphia, PA: WB Saunders; 2002.
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):750−5. https://www.ncbi.nlm.nih.gov/pubmed/10811699. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1736982. https://doi.org/10.1136/jnnp.68.6.750.
Muller C, Perrin P, Faller B, Richter S, Chantrel. Role of plasma exchange in thyroid storm. Ther Apher Dial. 2011;15(6):522-31. https://www.ncbi.nlm.nih.gov/pubmed/22107688. https://doi.org/10.1111/j.1744-9987.2011.01003.x.
Stensvold AD, Jorde R, Sundsfjord J. Late and transient increases in free T4 after radioiodine treatment for Graves' disease. J Endocrinol Invest. 1997;20(10):580. https://www.ncbi.nlm.nih.gov/pubmed/9438914. https://doi.org/10.1007/bf03346913.
Acharya SH, Avenell A, Philip S, Burr J, Bevan JS, Abraham P. Radioiodine therapy (RAI) for Graves' disease (GD) and the effect on ophthalmopathy: A systematic review. Clin Endocrinol (Oxf). 2008; 69(6):943–50. https://www.ncbi.nlm.nih.gov/pubmed/18429949. https://doi.org/10.1111/j.1365-2265.2008.03279.x.
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