NEUROMUSCULAR disorders in the course of hyperthyroidism are recognized1-3 and presently include exophthalmic ophthalmoplegia,4 thyrotoxic myopathy,5-10 myasthenia gravis,3,11,12 and periodic paralysis.13,14 Chronic thyrotoxic myopathy is most common but the mechanism of muscular dysfunction is obscure.
The clinical features of chronic thyrotoxic myopathy are due to progressive weakness, more pronounced in proximal muscles. Disability may be mild or severe. Muscular wasting is frequently seen, and muscle cramps also occur occasionally.15
McArdle16 described a patient with a lifelong history of cramps after muscular exercise and postulated that this disorder was due to a defect in muscle glycogen break-down. Subsequently, Schmid et al,17 Mommaerts et al,18 and Pearson et al19 found that muscle phosphorylase was lacking in similar patients. Since then, absence of muscle phosphorylase in additional cases has been confirmed.20,21 Recently, Tarui et al,22 and Layzer et al,23 described