Acute Thyrotoxic Myopathy Combined with Neck Pain: A Case Report.

Neuro endocrinology letters Pub Date : 2023-10-23
Shi-En Fu, Xing-Huan Liang, Zhi-Ping Tang, Ya-Qi Kuang, Cheng-Cheng Qiu, Xiao-Fan Liu, Hai-Yan Yang, Zhen-Xing Huang, Ying-Fen Qin, Yan Ma, Zuo-Jie Luo
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Abstract

Introduction: Acute thyrotoxic myopathy (ATM) is a rare and potentially lethal complication of thyrotoxicosis. The typical clinical symptoms of ATM are characterized by bulbar paralysis. Reports of the successful treatment of ATM are sporadic due to its low incidence. However, no English literature has reported Chinese patients with ATM and neck pain. Here, we report for the first time a Chinese patient with ATM and neck pain who recovered through large doses of systemic glucocorticoids and one intrathyroidal steroid injection.

Case report: A 23-year-old woman visited our hospital with a two-year history of progressive weakness of her bulbar muscles, hoarseness, cough when swallowing, dysphagia, and a one-month history of recurrent painful swelling of the thyroid gland. She was diagnosed with ATM, chronic thyrotoxic myopathy (CTM), and Graves' ophthalmopathy (GO) due to Graves' disease (GD). After she was treated with a combination of low-dose glucocorticoids, antithyroid drugs (ATDs), propranolol, and ultrasound-guided percutaneous intrathyroidal injection of glucocorticoids, her bulbar paralysis, proximal myopathy, and neck pain simultaneously improved without recurrence during follow-up. To our knowledge, this is the first case report of a patient with ATM, CTM, GD, GO and neck pain treated by administering a combination of low-dose glucocorticoids, one intrathyroidal steroid injection and antithyroid agents.

Conclusions: Clinicians should consider ATM and intervene with aggressive glucocorticoid therapy, and this is the key to reversing the progression of ATM when a patient has bulbar paralysis and thyrotoxic symptoms. Our case report references the clinical diagnosis and treatment of such cases.

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急性甲状腺毒性肌病合并颈部疼痛1例报告。
引言:急性甲状腺毒性肌病(ATM)是甲状腺毒症的一种罕见且可能致命的并发症。ATM的典型临床症状以延髓麻痹为特征。ATM成功治疗的报告是零星的,因为它的发病率很低。然而,没有英文文献报道中国患者患有ATM和颈部疼痛。在这里,我们首次报道了一名患有ATM和颈部疼痛的中国患者,他通过大剂量的全身糖皮质激素和一次甲状腺内类固醇注射康复。病例报告:一名23岁的女性来我院就诊,她有两年的延髓肌肉进行性无力、声音嘶哑、吞咽时咳嗽、吞咽困难病史,以及一个月的甲状腺复发性疼痛肿胀病史。她被诊断为ATM、慢性甲状腺毒性肌病(CTM)和Graves病引起的Graves眼病(GO)。在她接受低剂量糖皮质激素、抗甲状腺药物(ATD)、普萘洛尔和超声引导下经皮甲状腺内注射糖皮质激素的联合治疗后,她的延髓麻痹、近端肌病和颈部疼痛在随访期间同时得到改善,没有复发。据我们所知,这是第一例ATM、CTM、GD、GO和颈部疼痛患者通过联合使用低剂量糖皮质激素、一次甲状腺内类固醇注射和抗甲状腺药物进行治疗的病例报告。结论:临床医生应考虑ATM,并采取积极的糖皮质激素治疗进行干预,当患者出现延髓麻痹和甲状腺毒性症状时,这是逆转ATM进展的关键。我们的病例报告参考了此类病例的临床诊断和治疗。
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