0
June 1966, Vol 14, No. 6 >
Article | June 1966

Hypothyroid Myopathy: Title and subTitle BreakClinical, Electromyographical, and Ultrastructural Observations

FORBES H. NORRIS, JR., MD; BERNARD J. FANNER, MD
[+] Author Affiliations

Submitted for publication Dec 10, 1965; accepted Feb 4, 1966.

Read before the 90th Annual Meeting of the American Neurological Association, Atlantic City, NJ, June 16, 1965.

Reprint requests to Department of Pathology, University of Rochester Medical Center, Rochester, NY 14620 (Dr. Panner) or Institute of Medical Sciences, Presbyterian Medical Center, San Francisco 94115 (Dr. Norris).


Arch Neurol. 1966;14(6):574-589. doi:10.1001/archneur.1966.00470120006002
Text Size: A A A
Published online
Article
References
Comments

THE FIRST report of muscular changes in hypothyroidism was Kocher's1 account of muscular enlargement, weakness, and slow movements in a young cretin. Many authors, however, credit Debré and Semelaigne,2 who renewed interest in this childhood syndrome and cured one of their cases with thyroid. In the meantime, Hoffmann3 described an adult with enlarged muscles, weakness, slow movements, and delayed relaxation. He differentiated the abnormal relaxation from myotonia by its failure to improve after several contractions, as occurs in myotonia, a distinction not confirmed until after clinical application of electro-myography 39 years later.4 Hoffmann3 also reported a cure with thyroid. Later authors described numerous cases in myxedematous adults who also had painful muscle spasms and muscle percussion reactions similar to myotonia. Electromyography, however, demonstrated electrical silence in most cases during the myotonic-like manifestations, hence the descriptive terms pseudomyotonia and myotonoid reaction.5,6

The major points

REFERENCES

1 +
Kocher, T.:  Zur Verhütung der Cretinismus und cretinoïder Zustande nach neuen Forschungen , Deutsch Z Chir 26:556, 1892;.
2 +
Debré, R., and Semelaigne, G.:  Syndrome of Diffuse Muscular Hypertrophy in Infants Causing Athletic Appearance , Amer J Dis Child 50:1351, 1935;.
3 +
Hoffmann, J.:  Weitere Beotrag zur Lehre von der Tetanie , Deutsch Z Nervenheilk 9:278, 1897;.
4 +
Nevin, S.: Personal communication cited by Poncher and Woodward.12
5 +
Thomasen, E.: Myotonia , Copenhagen: Universitetsforlaget i Aarhus, 1948;, pp 80-91.
6 +
Wilson, J., and Walton, J.N.:  Some Muscular Manifestations of Hypothyroidism , J Neurol Neurosurg Psychiat 22:320, 1959;.
7 +
Weitz, W.:  Über eigentümliche Muskelerscheinungen bei Myxoedem , Deutsch Z Nervenheilk 120:297, 1931;.
8 +
Hesser, F.H.:  Hypertrophia Musculorum Vera With Hypothyroidism , Bull Hopkins Hosp 66:353, 1940;.
9 +
Slauk, A.:  Beiträge zur Kenntnis der Muskelveränderungen bei Myxoedem und Myotonia Atrophica , Z Neurol Psychiat 67:276, 1921;.
10 +
Valdés Diaz, R.: Miotonia Congenita, Arch Med Inf 1:15, 1932, and personal communication cited by Poncher and Woodward.12
11 +
Denoyelle, de G., and Sirand, E.:  Myxoedéme et hypertrophie musculaire généralisée , Bull Soc Pediat 36:590, 1938;.
12 +
Poncher, H.G., and Woodward, H.:  Pathogenesis and Treatment of Myotonia Congenita , Amer J Dis Child 52:1065, 1936;.
13 +
Adams, R.D.; Denny-Brown, D.; and Pearson, C.M.: Diseases of Muscle , ed 2, New York: Harper & Row, Publishers, Inc., 1962;, pp 228-232, 602-603.
14 +
Norris, F.H., Jr., and Panner, B.J.: " Hypothyroid Myopathy ," in Yahr, M. D. (ed.): Transactions of the American Neurological Association , New York: Springer Publishing Co., Inc., 1965;, vol 90, pp 203-207.
15 +
Engel, A.G.:  Thyroid Function and Myasthenia Gravis , Arch Neurol 4:663, 1961;.
16 +
Drachman, D.B.:  Myasthenia Gravis and Thyroid Gland , New Engl J Med 266:330, 1962;.
17 +
Sahay, B.M.; Blendis, L.M.; and Greene, R.:  Relation Between Myasthenia Gravis and Thyroid Disease , Brit Med J 1:762, 1965;.
18 +
Norris, F.H., Jr.:  Neuromuscular Transmission in Thyroid Disease , Ann Intern Med 64:18, 1966;.
19 +
Norris, F.H., Jr.: The EMG , New York and London: Grune & Stratton, Inc., 1963;.
20 +
Engel, W.K.:  The Essentiality of Histo- and Cytochemical Studies of Skeletal Muscle in In vestigation of Neuromuscular Disease , Neurology 12:778, 1962;.
21 +
Luft, J.H.:  Improvements in Epoxy Resin Embedding Methods , J Biophys Biochem Cytol 9:409, 1961;.
22 +
Reynolds, E.S.:  Use of Lead Citrate at High pH as Electron-Opaque Stain in Electron Microscopy , J Cell Biol 17:208, 1963;.
23 +
Price, H.M.:  Skeletal Muscle Fiber in Light of Electron Microscope Studies , Amer J Med 35:589, 1963;.
24 +
Revel, J.P.:  Electron Microscopy of Glycogen , J Histochem Cytochem 12:104, 1964;.
25 +
Nickel, S.N., et al:  Myxedema Neuropathy and Myopathy , Neurology 11:125, 1961;.
26 +
Nickel, S.N., and Frame, B.: " Muscular System in Myxedema ," in Crispell, K.R.: Current Concepts in Hypothyroidism , New York: Macmillan Co., 1963;, pp 175-182.
27 +
Hall, B.E.; Sunderman, F.W.; and Gittings, J.C.:  Congenital Muscular Hypertrophy , Amer J Dis Child 52:773, 1936;.
28 +
Kugelberg, E.; Muller, R.; and Astrom, K.-E.:  Hypothyroid Myopathy , Electroenceph Clin Neurophysiol 11:850, 1959;.
29 +
Astrom, K.-E.; Kugelberg, E.; and Muller, R.:  Hypothyroid Myopathy , Arch Neurol 5:472, 1961;.
30 +
Lambert, E.H., and Sayre, O.P.:  Myopathy in Rabbits Following Thyroidectomy , Amer J Physiol 183:636, 1955;.
31 +
Waldstein, S.S., et al:  Electromyogram in Myxedema , Arch Intern Med 101:97, 1958;.
32 +
Asboe-Hansen, G.; Iverson, K.; and Wichmann, R.:  Malignant Exophthalmos , Acta Endocr 11:376, 1952;.
33 +
Greenawalt, J.W.; Foster, G.V.; and Lehninger, A.L.: "Observation of Unusual Membranous Structures Associated With Liver Mitochondria in Thyrotoxic Rats," in Proceedings of the Fifth International Electron Microscopy Congress, New York: International Electromicroscopy Society, 1962, vol 2, pp 00-5.
34 +
Wojtczak, L., and Lehninger, A.L.:  Formation and Disappearance of Endogenous Uncoupling Factor During Swelling and Contraction of Mitochondria , Biochim Biophys Acta 51:442, 1961;.
35 +
Bronk, J.R.:  Nature of Energy Requirement for Amino Acid Incorporation by Isolated Mitochondria and Its Significance for Thyroid Hormone Action , Proc Natl Acad Sci USA 50:524, 1963;.
36 +
Sokoloff, L., et al:  Thyroxine Stimulation of Amino Acid Incorporation Into Protein , J Biol Chem 238:1432, 1963;.
37 +
Klee, C.B., and Sokoloff, L.:  Mitochondrial Differences in Mature and Immature Brain , J Neurochem 11:709, 1964;.
38 +
Hoch, F.L.:  Thyrotoxicosis as Disease of Mitochondria , New Eng J Med 266:446 & 498, 1962;.
39 +
Luft, R., et al:  Case of Severe Hypermetabolism of Nonthyroid Origin With Defect in Maintenance of Mitochrondrial Respiratory Control , J Clin Invest 41:1776, 1962;.
40 +
Shy, G.M., and Gonatas, N.K.:  Myopathy With Giant Abnormal Mitochondria , Science 145:493, 1964;.
41 +
Karnovsky, M.J.:  Fine Structure of Mitochondria in Frog Nephron Correlated With Cytochrome Oxidase Activity , Exp Molec Path 2:347, 1963;.
42 +
Wilson, J.W., and Leduc, E.H.:  Mitochondrial Changes in Liver of Essential Fatty Acid-Deficient Mice , J Cell Biol 16:281, 1963;.
43 +
Revel, J.P.; Fawcett, D.W.; and Philpott, C.W.:  Observations on Mitochondrial Structure , J Cell Biol 16:187, 1963;.
44 +
Yamada, E.:  Crystalline Body Found in Rod Inner Segment of Frog's Eye , J Biophys Biochem Cytol 6:517, 1959;.
45 +
Ward, R.T.:  Origin of Protein and Fatty Yolk in Rana Pipiens , J Cell Biol 14:309, 1962;.
46 +
Gustafsson, R., et al:  Relationship Between Structure and Activity of Rat Skeletal Muscle Mitochondria After Thyroidectomy and Thyroid Hormone Treatment , J Cell Biol 26:555, 1965;.
47 +
Broitman, S.A., et al:  Absorption and Disposition of Xylose in Thyrotoxicosis and Myxedema , New Eng J Med 270:333, 1964;.
48 +
Pettinger, W.A.; Talner, L.; and Ferris, T.F.:  Inappropriate Secretion of Antidiuretic Hormone Due to Myxedema , New Eng J Med 272:362, 1965;.
49 +
Raskin, N.H., and Fishman, R.A.:  Effects of Thyroid in Permeability Composition, and Electrolyte Metabolism of Brain and Other Tissues , Arch Neurol 14:21, 1966;.
50 +
Shy, G.M., et al:  Studies in Familial Periodic Paralysis , Exp Neurol 3:53, 1961;.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Kocher, T.:  Zur Verhütung der Cretinismus und cretinoïder Zustande nach neuen Forschungen , Deutsch Z Chir 26:556, 1892;.
2 +
Debré, R., and Semelaigne, G.:  Syndrome of Diffuse Muscular Hypertrophy in Infants Causing Athletic Appearance , Amer J Dis Child 50:1351, 1935;.
3 +
Hoffmann, J.:  Weitere Beotrag zur Lehre von der Tetanie , Deutsch Z Nervenheilk 9:278, 1897;.
4 +
Nevin, S.: Personal communication cited by Poncher and Woodward.12
5 +
Thomasen, E.: Myotonia , Copenhagen: Universitetsforlaget i Aarhus, 1948;, pp 80-91.
6 +
Wilson, J., and Walton, J.N.:  Some Muscular Manifestations of Hypothyroidism , J Neurol Neurosurg Psychiat 22:320, 1959;.
7 +
Weitz, W.:  Über eigentümliche Muskelerscheinungen bei Myxoedem , Deutsch Z Nervenheilk 120:297, 1931;.
8 +
Hesser, F.H.:  Hypertrophia Musculorum Vera With Hypothyroidism , Bull Hopkins Hosp 66:353, 1940;.
9 +
Slauk, A.:  Beiträge zur Kenntnis der Muskelveränderungen bei Myxoedem und Myotonia Atrophica , Z Neurol Psychiat 67:276, 1921;.
10 +
Valdés Diaz, R.: Miotonia Congenita, Arch Med Inf 1:15, 1932, and personal communication cited by Poncher and Woodward.12
11 +
Denoyelle, de G., and Sirand, E.:  Myxoedéme et hypertrophie musculaire généralisée , Bull Soc Pediat 36:590, 1938;.
12 +
Poncher, H.G., and Woodward, H.:  Pathogenesis and Treatment of Myotonia Congenita , Amer J Dis Child 52:1065, 1936;.
13 +
Adams, R.D.; Denny-Brown, D.; and Pearson, C.M.: Diseases of Muscle , ed 2, New York: Harper & Row, Publishers, Inc., 1962;, pp 228-232, 602-603.
14 +
Norris, F.H., Jr., and Panner, B.J.: " Hypothyroid Myopathy ," in Yahr, M. D. (ed.): Transactions of the American Neurological Association , New York: Springer Publishing Co., Inc., 1965;, vol 90, pp 203-207.
15 +
Engel, A.G.:  Thyroid Function and Myasthenia Gravis , Arch Neurol 4:663, 1961;.
16 +
Drachman, D.B.:  Myasthenia Gravis and Thyroid Gland , New Engl J Med 266:330, 1962;.
17 +
Sahay, B.M.; Blendis, L.M.; and Greene, R.:  Relation Between Myasthenia Gravis and Thyroid Disease , Brit Med J 1:762, 1965;.
18 +
Norris, F.H., Jr.:  Neuromuscular Transmission in Thyroid Disease , Ann Intern Med 64:18, 1966;.
19 +
Norris, F.H., Jr.: The EMG , New York and London: Grune & Stratton, Inc., 1963;.
20 +
Engel, W.K.:  The Essentiality of Histo- and Cytochemical Studies of Skeletal Muscle in In vestigation of Neuromuscular Disease , Neurology 12:778, 1962;.
21 +
Luft, J.H.:  Improvements in Epoxy Resin Embedding Methods , J Biophys Biochem Cytol 9:409, 1961;.
22 +
Reynolds, E.S.:  Use of Lead Citrate at High pH as Electron-Opaque Stain in Electron Microscopy , J Cell Biol 17:208, 1963;.
23 +
Price, H.M.:  Skeletal Muscle Fiber in Light of Electron Microscope Studies , Amer J Med 35:589, 1963;.
24 +
Revel, J.P.:  Electron Microscopy of Glycogen , J Histochem Cytochem 12:104, 1964;.
25 +
Nickel, S.N., et al:  Myxedema Neuropathy and Myopathy , Neurology 11:125, 1961;.
26 +
Nickel, S.N., and Frame, B.: " Muscular System in Myxedema ," in Crispell, K.R.: Current Concepts in Hypothyroidism , New York: Macmillan Co., 1963;, pp 175-182.
27 +
Hall, B.E.; Sunderman, F.W.; and Gittings, J.C.:  Congenital Muscular Hypertrophy , Amer J Dis Child 52:773, 1936;.
28 +
Kugelberg, E.; Muller, R.; and Astrom, K.-E.:  Hypothyroid Myopathy , Electroenceph Clin Neurophysiol 11:850, 1959;.
29 +
Astrom, K.-E.; Kugelberg, E.; and Muller, R.:  Hypothyroid Myopathy , Arch Neurol 5:472, 1961;.
30 +
Lambert, E.H., and Sayre, O.P.:  Myopathy in Rabbits Following Thyroidectomy , Amer J Physiol 183:636, 1955;.
31 +
Waldstein, S.S., et al:  Electromyogram in Myxedema , Arch Intern Med 101:97, 1958;.
32 +
Asboe-Hansen, G.; Iverson, K.; and Wichmann, R.:  Malignant Exophthalmos , Acta Endocr 11:376, 1952;.
33 +
Greenawalt, J.W.; Foster, G.V.; and Lehninger, A.L.: "Observation of Unusual Membranous Structures Associated With Liver Mitochondria in Thyrotoxic Rats," in Proceedings of the Fifth International Electron Microscopy Congress, New York: International Electromicroscopy Society, 1962, vol 2, pp 00-5.
34 +
Wojtczak, L., and Lehninger, A.L.:  Formation and Disappearance of Endogenous Uncoupling Factor During Swelling and Contraction of Mitochondria , Biochim Biophys Acta 51:442, 1961;.
35 +
Bronk, J.R.:  Nature of Energy Requirement for Amino Acid Incorporation by Isolated Mitochondria and Its Significance for Thyroid Hormone Action , Proc Natl Acad Sci USA 50:524, 1963;.
36 +
Sokoloff, L., et al:  Thyroxine Stimulation of Amino Acid Incorporation Into Protein , J Biol Chem 238:1432, 1963;.
37 +
Klee, C.B., and Sokoloff, L.:  Mitochondrial Differences in Mature and Immature Brain , J Neurochem 11:709, 1964;.
38 +
Hoch, F.L.:  Thyrotoxicosis as Disease of Mitochondria , New Eng J Med 266:446 & 498, 1962;.
39 +
Luft, R., et al:  Case of Severe Hypermetabolism of Nonthyroid Origin With Defect in Maintenance of Mitochrondrial Respiratory Control , J Clin Invest 41:1776, 1962;.
40 +
Shy, G.M., and Gonatas, N.K.:  Myopathy With Giant Abnormal Mitochondria , Science 145:493, 1964;.
41 +
Karnovsky, M.J.:  Fine Structure of Mitochondria in Frog Nephron Correlated With Cytochrome Oxidase Activity , Exp Molec Path 2:347, 1963;.
42 +
Wilson, J.W., and Leduc, E.H.:  Mitochondrial Changes in Liver of Essential Fatty Acid-Deficient Mice , J Cell Biol 16:281, 1963;.
43 +
Revel, J.P.; Fawcett, D.W.; and Philpott, C.W.:  Observations on Mitochondrial Structure , J Cell Biol 16:187, 1963;.
44 +
Yamada, E.:  Crystalline Body Found in Rod Inner Segment of Frog's Eye , J Biophys Biochem Cytol 6:517, 1959;.
45 +
Ward, R.T.:  Origin of Protein and Fatty Yolk in Rana Pipiens , J Cell Biol 14:309, 1962;.
46 +
Gustafsson, R., et al:  Relationship Between Structure and Activity of Rat Skeletal Muscle Mitochondria After Thyroidectomy and Thyroid Hormone Treatment , J Cell Biol 26:555, 1965;.
47 +
Broitman, S.A., et al:  Absorption and Disposition of Xylose in Thyrotoxicosis and Myxedema , New Eng J Med 270:333, 1964;.
48 +
Pettinger, W.A.; Talner, L.; and Ferris, T.F.:  Inappropriate Secretion of Antidiuretic Hormone Due to Myxedema , New Eng J Med 272:362, 1965;.
49 +
Raskin, N.H., and Fishman, R.A.:  Effects of Thyroid in Permeability Composition, and Electrolyte Metabolism of Brain and Other Tissues , Arch Neurol 14:21, 1966;.
50 +
Shy, G.M., et al:  Studies in Familial Periodic Paralysis , Exp Neurol 3:53, 1961;.

Correspondence

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems