[Hypothyroidism with leading myopathy in a patient suffering from systemic lupus erythematosus and Hashimoto's thyroiditis]. 2008

Antonia Judex, and Wolfgang Hartung, and Jürgen Schölmerich, and Martin Fleck
Klinik für Rheumatologie und Klinische Immunologie, Asklepios Klinikum, Bad Abbach, Germany. a.judex@asklepios.com

BACKGROUND Muscle weakness with or without elevation of serum creatine kinase (CK) is a common complaint, which is a diagnostic challenge for the treating physician. Either infectious, neurologic, iatrogenic, genetic or endocrinologic and rheumatologic causes should be considered. METHODS A 66-year-old female patient with a history of systemic lupus erythematosus (SLE) currently in remission presented herself with muscle weakness, myalgias and elevated CK (1618 U/l) to the authors' hospital. A flare of the SLE as cause of the symptoms could be ruled out diagnostically. Instead, a Hashimoto's-associated hypothyroidism was detected. Treatment with L-thyroxine resulted in rapid improvement of symptoms, and CK levels returned to normal. CONCLUSIONS Although a myositis can be observed in SLE patients suffering from muscle weakness with elevated CK levels, a careful evaluation is warranted. In the presented case, hypothyroidism due to Hashimoto's thyroiditis was the real culprit of the symptoms.

UI MeSH Term Description Entries
D007037 Hypothyroidism A syndrome that results from abnormally low secretion of THYROID HORMONES from the THYROID GLAND, leading to a decrease in BASAL METABOLIC RATE. In its most severe form, there is accumulation of MUCOPOLYSACCHARIDES in the SKIN and EDEMA, known as MYXEDEMA. It may be primary or secondary due to other pituitary disease, or hypothalamic dysfunction. Central Hypothyroidism,Primary Hypothyroidism,Secondary Hypothyroidism,TSH Deficiency,Thyroid-Stimulating Hormone Deficiency,Central Hypothyroidisms,Deficiency, TSH,Deficiency, Thyroid-Stimulating Hormone,Hormone Deficiency, Thyroid-Stimulating,Hypothyroidism, Central,Hypothyroidism, Primary,Hypothyroidism, Secondary,Hypothyroidisms,Primary Hypothyroidisms,Secondary Hypothyroidisms,TSH Deficiencies,Thyroid Stimulating Hormone Deficiency,Thyroid-Stimulating Hormone Deficiencies
D008180 Lupus Erythematosus, Systemic A chronic, relapsing, inflammatory, and often febrile multisystemic disorder of connective tissue, characterized principally by involvement of the skin, joints, kidneys, and serosal membranes. It is of unknown etiology, but is thought to represent a failure of the regulatory mechanisms of the autoimmune system. The disease is marked by a wide range of system dysfunctions, an elevated erythrocyte sedimentation rate, and the formation of LE cells in the blood or bone marrow. Libman-Sacks Disease,Lupus Erythematosus Disseminatus,Systemic Lupus Erythematosus,Disease, Libman-Sacks,Libman Sacks Disease
D003402 Creatine Kinase A transferase that catalyzes formation of PHOSPHOCREATINE from ATP + CREATINE. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic ISOENZYMES have been identified in human tissues: the MM type from SKELETAL MUSCLE, the MB type from myocardial tissue and the BB type from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine kinase refers to creatine kinase complexed with other serum proteins. Creatine Phosphokinase,ADP Phosphocreatine Phosphotransferase,ATP Creatine Phosphotransferase,Macro-Creatine Kinase,Creatine Phosphotransferase, ATP,Kinase, Creatine,Macro Creatine Kinase,Phosphocreatine Phosphotransferase, ADP,Phosphokinase, Creatine,Phosphotransferase, ADP Phosphocreatine,Phosphotransferase, ATP Creatine
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D013960 Thyroid Function Tests Blood tests used to evaluate the functioning of the thyroid gland. Jostel's TSH Index,Jostel's Thyrotropin Index,Protein-Bound Iodine Test,SPINA-GD,SPINA-GT,Secretory Capacity of the Thyroid Gland,Sum Activity of Peripheral Deiodinases,Thyrotroph Thyroid Hormone Sensitivity Index,Thyroid Gland Function Tests,Function Test, Thyroid,Iodine Test, Protein-Bound,Jostel TSH Index,Jostel Thyrotropin Index,Jostel's TSH Indices,Jostels TSH Index,Jostels Thyrotropin Index,Protein Bound Iodine Test,Protein-Bound Iodine Tests,TSH Index, Jostel's,Test, Protein-Bound Iodine,Test, Thyroid Function,Thyroid Function Test,Thyrotropin Index, Jostel's
D050031 Hashimoto Disease Chronic autoimmune thyroiditis, characterized by the presence of high serum thyroid AUTOANTIBODIES; GOITER; and HYPOTHYROIDISM. Hashimoto's Disease,Chronic Lymphocytic Thyroiditis,Hashimoto Struma,Hashimoto Thyroiditis,Hashimoto's Struma,Hashimoto's Syndrome,Chronic Lymphocytic Thyroiditides,Disease, Hashimoto,Disease, Hashimoto's,Hashimoto Syndrome,Hashimoto Thyroiditides,Hashimoto's Syndromes,Hashimotos Disease,Hashimotos Syndrome,Lymphocytic Thyroiditides, Chronic,Lymphocytic Thyroiditis, Chronic,Syndrome, Hashimoto's,Syndromes, Hashimoto's,Thyroiditides, Chronic Lymphocytic,Thyroiditides, Hashimoto,Thyroiditis, Chronic Lymphocytic,Thyroiditis, Hashimoto
D018908 Muscle Weakness A vague complaint of debility, fatigue, or exhaustion attributable to weakness of various muscles. The weakness can be characterized as subacute or chronic, often progressive, and is a manifestation of many muscle and neuromuscular diseases. (From Wyngaarden et al., Cecil Textbook of Medicine, 19th ed, p2251) Muscular Weakness,Muscle Weaknesses,Muscular Weaknesses,Weakness, Muscle,Weakness, Muscular,Weaknesses, Muscle,Weaknesses, Muscular

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