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Rhabdomyolysis associated with hyperthyroidism.

Daniel M Lichtstein1, Roque B Arteaga2

  • 1Department of Medicine, Miller School of Medicine, University of Miami Jackson Memorial Medical Center, Miami, Florida.

The American Journal of the Medical Sciences
|August 16, 2006
PubMed
Summary
This summary is machine-generated.

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This case report details a patient with Graves disease who developed rhabdomyolysis. Prompt treatment of hyperthyroidism resolved the condition, highlighting a rare but serious complication.

Area of Science:

  • Endocrinology
  • Neurology
  • Internal Medicine

Background:

  • Nontraumatic rhabdomyolysis is linked to various conditions including substance abuse, seizures, and metabolic disorders.
  • Hyperthyroidism commonly presents with neuromuscular issues like thyrotoxic myopathy, typically with normal creatine phosphokinase.
  • Rhabdomyolysis secondary to thyrotoxicosis is exceedingly rare, with only three prior cases reported.

Observation:

  • A 26-year-old woman with hypertension presented with symptoms of hyperthyroidism, including blurred vision, palpitations, and weight loss.
  • Physical examination revealed exophthalmos and goiter; Graves disease was diagnosed based on positive TPO antibodies and abnormal thyroid function tests.
  • Following diagnosis and treatment with propylthiouracil, the patient developed weakness and myalgias, with elevated creatine phosphokinase levels.

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Findings:

  • The patient's laboratory results showed elevated free T4 and T3 with suppressed TSH, alongside significantly elevated creatine phosphokinase (1276 U/L).
  • Despite normal electrolytes and renal function, the clinical presentation and labs indicated rhabdomyolysis.
  • Treatment with continued propylthiouracil and aggressive fluid resuscitation led to normalization of thyroid hormones and creatine phosphokinase, resolving symptoms.

Implications:

  • This case reinforces that hyperthyroidism can precipitate rhabdomyolysis, possibly due to increased muscle energy demands and substrate depletion.
  • It underscores the importance of considering thyrotoxicosis in the differential diagnosis of rhabdomyolysis, even in its absence of typical neuromuscular symptoms.
  • This report adds to the scarce literature, emphasizing the need for vigilance regarding this rare but severe complication of hyperthyroidism.