Skip to main content

Advertisement

SpringerLink
Log in

Polymyositis associated with hypothyroidism or hyperthyroidism: two cases and review of the literature

  • Review Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Studies confirming a possible relationship of polymyositis within thyroid dysfunction, either hypothyroidism or hyperthyroidism, are hardly available. To define the association, identify clinical, laboratory, electromyographic, and pathologic features in polymyositis (PM) patients with hypothyroidism or hyperthyroidism, we conducted a MEDLINE and Chinese biomedicine database search to identify relevant literature published in the past 25 years. Seventeen cases were included. All patients were female (10 hypothyroidism patients, seven hyperthyroidism patients). The mean (SD) age of PM, hypothyroidism, and hyperthyroidism at diagnosis was 54.8 (16.7), 55.5 (16.5), and 32.7 years (10.2), respectively. PM diagnosis can precede or parallel hypothyroidism while PM may occur following the diagnosis of hyperthyroidism. The most common comorbidities were malignant tumors in these disorders, including thymoma, colon cancer, and thyroid cancer. Muscle weakness was described in 100% of patients. Other common manifestations included muscles’ atrophy and pain, deep tendon reflexes, polyarthralgia, and dysphagia. Most patients had markedly elevated creatine kinase and the presence of anti-Sjogren’s syndrome A (SSA) antibodies was also found in two cases. Malignancy associated with PM may more frequently occur in hypothyroidism than in hyperthyroidism. The abnormalities on electromyography and biopsy did not differ from those findings of PM. Therapy consisting of corticosteroids, thyroid hormone, or anti-thyroid drugs was administrated; however, poor prognosis seemed to be associated with malignant tumors as well as older age and the presence of anti-SSA antibodies. It is reasonable to suggest that those patients should be routinely evaluated for thyroid function, especially in older female and patients suffering from cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bohan A, Peter JB (1975) Polymyositis and dermatomyositis. N Engl J Med 292:344–347

    Article  PubMed  CAS  Google Scholar 

  2. Dalakas MC, Hohlfeld R (2003) Polymyositis and dermatomyositis. Lancet 362:971–982

    Article  PubMed  CAS  Google Scholar 

  3. Nakajima A, Sendo W, Tsutsumino M, Koseki Y, Ichikawa N, Akama H et al (1998) Acute sympathetic hyperfunction in overlapping syndromes of systemic lupus erythematosus and polymyositis. J Rheumatol 25:1638–1641

    PubMed  CAS  Google Scholar 

  4. Martínez-Cordero E, León DE, Ortega LA (2001) Association of polymyositis with rheumatoid arthritis. Rheumatol Int 20:119–123

    Article  PubMed  Google Scholar 

  5. Gran JT, Myklebust G (1992) The concomitant occurrence of Sjogren’s syndrome and polymyositis. Scand J Rheumatol 21:150–154

    Article  PubMed  CAS  Google Scholar 

  6. Silas AM, White AG (1976) Progressive systemic sclerosis and polymyositis. Proc R Soc Med 69:808–809

    PubMed  CAS  Google Scholar 

  7. Canaris GJ, Manowits NR, Mayor G, Ridgway EC (2000) The Colorado thyroid disease prevalence study. Arch Intern Med 160:526–534

    Article  PubMed  CAS  Google Scholar 

  8. Tsai RT, Chang TC, Wang CR, Chuang CY, Chen CY (1993) Thyroid disorders in Chinese patients with systemic lupus erythematosus. Rheumatol Int 13:9–13

    Article  PubMed  CAS  Google Scholar 

  9. Andonopoulos AP, Siambi V, Makri M, Christofidou M, Markou C, Vagenakis AG (1996) Thyroid function and immune profile in rheumatoid arthritis. A controlled study. Clin Rheumatol 15:599–603

    Article  PubMed  CAS  Google Scholar 

  10. Gaches F, Delaire L, Nadalon S, Loustaud-Ratti V, Vidal E (1998) Frequency of autoimmune diseases in 218 patients with autoimmune thyroid pathologies. Rev Méd Interne 19:173–179

    Article  PubMed  CAS  Google Scholar 

  11. Szyper-Kravitz M, Marai I, Shoenfeld Y (2005) Coexistence of thyroid autoimmunity with other autoimmune diseases: friend or foe? Additional aspects on the mosaic of autoimmunity. Autoimmunity 38:247–255

    Article  PubMed  CAS  Google Scholar 

  12. Biró E, Szekanecz Z, Dankó K, Kiss E, Szabó NA, Szűcs G et al (2006) Association of systemic and thyroid autoimmune diseases. Clin Rheumatol 25:240–245

    Article  PubMed  Google Scholar 

  13. Jenkins RC, Weetman AP (2002) Disease associations with autoimmune thyroid disease. Thyroid 12:977–988

    Article  PubMed  Google Scholar 

  14. Paul S, Li L, Kalaga R, O’Dell J, Dannenbring RE Jr, Swindells S (1997) Characterization of thyroglobulin-directed and polyreactive catalytic antibodies in autoimmune disease. J Immunol 159:1530–1536

    PubMed  CAS  Google Scholar 

  15. Selva-O’Callaghan A, Redondo-Benito A, Trallero-Araguás E, Martínez-Gómez X, Palou E, Vilardell-Tarres M (2007) Clinical significance of thyroid disease in patients with inflammatory myopathy. Medicine (Baltimore) 86:293–298

    Article  Google Scholar 

  16. Robert DU (1991) The pathogenesis of autoimmune thyroiditis. N Engl J Med 324:278–279

    Google Scholar 

  17. García-Porrúa C, González-Gay MA, Fernández-Lamelo F, Paz-Carreira JM, Lavilla E, González-López MA (1998) Simultaneous development of SLE-like syndrome and autoimmune thyroiditis following alpha-interferon treatment. Clin Exp Rheumatol 16:107–108

    PubMed  Google Scholar 

  18. Weetman AP, McGregor AM (1994) Autoimmune thyroid disease: further developments in our understanding. Endocr Rev 15:788–830

    PubMed  CAS  Google Scholar 

  19. Lazarus JH (2007) Hyperthyroidism. Lancet 349:339–343

    Article  Google Scholar 

  20. Miyata M, Fukaya E, Takagi T, Watanabe K, Saito H, Ito M et al (1998) Two patients with polymyositis or dermatomyositis complicated with massive pleural effusion. Intern Med 37:1058–1063

    Article  PubMed  CAS  Google Scholar 

  21. Shergy WJ, Caldwell DS (1998) Polymyositis after propylthiouracil treatment for hyperthyroidism. Ann Rheum Dis 47:340–343

    Article  Google Scholar 

  22. Smith CJ, Staniland JR (2003) A difficult case of inflammatory myositis. Age Ageing 32:351–352

    Article  PubMed  Google Scholar 

  23. Wang YG, Xu B, Fang H, Liu GY, Yuan LM, Fang DR (2003) A case of polymyositis associated with hypothyroidism. J Clin Dermatol 32:345

    CAS  Google Scholar 

  24. Fujitake J, Ishikawa Y, Ishimaru S, Koh T, Tatsuoka Y (1994) Localized polymyositis associated with chronic thyroiditis. J Rheumatol 21:1147–1149

    PubMed  CAS  Google Scholar 

  25. Taniguchi A, Niwa A, Nakayama S, Hamaguchi Y, Kuzuhara S (1995) Polymyositis with rimmed vacuoles in a case of chronic thyroiditis. Rinsho Shinkeigaku 35:403–407

    PubMed  CAS  Google Scholar 

  26. Le Marc’hadour F, Martins Ramos J, Pasquier B, Pasquier D, Couderc P (1989) Association of thymus carcinoma, Hashimoto’s thyroiditis and polymyositis. Anatomoclinical case with autopsy findings. Ann Pathol 9:355–359

    PubMed  Google Scholar 

  27. Pécoud A, Essinger A, Miklossy J, Ribaux C (1989) Cachexia, pain and muscle weakness in a 69-year-old woman. Schweiz Med Wochenschr 119:407–415

    PubMed  Google Scholar 

  28. Mihori A, Morio T, Nakayama M, Ono S, Shimizu N (1998) A case of fasciitis associated with Basedow’s disease and polymyositis. Rinsho Shinkeigaku 38:27–31

    PubMed  CAS  Google Scholar 

  29. Kobayashi T, Asakawa H, Komoike Y, Nakano Y, Tamaki Y, Monden M (1997) A patient with Graves’ disease, myasthenia gravis, and polymyositis. Thyroid 7:631–632

    Article  PubMed  CAS  Google Scholar 

  30. Stevanato F, Martinello F, Pesce R, Terribile IV, Saia A, Trevisan CP (1991) A case of polymyositis in autoimmune thyroiditis with hyperthyroidism. Riv Neurol 61:17–19

    PubMed  CAS  Google Scholar 

  31. Araki K, Minami Y, Ueda Y, Kashima K (1990) A case of polymyositis associated with chronic thyroiditis presenting as hyperthyroidism. Jpn Med 29:46–51

    CAS  Google Scholar 

  32. Sakata S, Fuwa Y, Goshima E, Nakamura S, Yamakita N, Maeda M et al (1989) A case of Graves’ disease associated with polymyositis. J Endocrinol Investig 12:837–840

    CAS  Google Scholar 

  33. Stevanato F, Boscaro M, Manno M, Busnardo B (1985) Association of polymyositis and autoimmune thyroiditis with hyperthyroidism. Presse Méd 14:231

    PubMed  CAS  Google Scholar 

  34. Lukjanowicz M, Bobrowska-Snarska D, Brzosko M (2006) Coexistence of hypothyroidism with polymyositis or dermatomyositis. Ann Acad Med Stetin 52(Suppl 2):49–55

    PubMed  Google Scholar 

  35. Dalakas MC (1991) Polymyositis, dermatomyositis, and inclusion body myositis. N Engl J Med 325:1487–1498

    Article  PubMed  CAS  Google Scholar 

  36. Papanicolaou DA (2000) Euthyroid sick syndrome and the role of cytokines. Rev Endocr Metab Disord 1:43–48

    Article  PubMed  CAS  Google Scholar 

  37. Punzi L, Schiavon F, Ramonda R, Cavasin F, Ruffatti A, Todesco S (1991) Anti-thyroid antibody in synovial fluid as a revealing feature of seronegative autoimmune thyroiditis. Clin Rheumatol 10:181–183

    Article  PubMed  CAS  Google Scholar 

  38. Hill CL, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, Airio A et al (2001) Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet 357:96–100

    Article  PubMed  CAS  Google Scholar 

  39. Zampieri S, Valente M, Adami N, Biral D, Ghirardello A, Rampudda ME et al (2010) Polymyositis, dermatomyositis and malignancy: a further intriguing link. Autoimmun Rev 9:449–453

    Article  PubMed  CAS  Google Scholar 

  40. Kuijpens JL, Nyklíctek I, Louwman MW, Weetman TA, Pop VJ, Coebergh JW (2005) Hypothyroidism might be related to breast cancer in post-menopausal women. Thyroid 15:1253–1259

    Article  PubMed  CAS  Google Scholar 

  41. Franklyn JA, Maisonneuve P, Sheppard M, Betteridge J, Boyle P (1999) Cancer incidence and mortality after radioiodine treatment for hyperthyroidism: a population-based cohort study. Lancet 353:2111–2115

    Article  PubMed  CAS  Google Scholar 

  42. Tunbridge WM, Vanderpump MP (2000) Population screening for autoimmune thyroid disease. Endocrinol Metab Clin North Am 29:239–253

    Article  PubMed  CAS  Google Scholar 

  43. Trzepacz PT, Klein I, Robert M, Greenhouse J, Levey GS (1989) Graves’ disease: an analysis of thyroid hormone levels and hyperthyroid signs and symptoms. Am J Med 87:558–561

    Article  PubMed  CAS  Google Scholar 

  44. Madariaga MG, Gamarra N, Dempsey S, Barsano CP (2002) Polymyositis-like syndrome in hypothyroidism: review of cases reported over the past twenty-five years. Thyroid 12:331–336

    Article  PubMed  Google Scholar 

  45. Van der Meulen MF, Bronner IM, Hoogendijk JE, Burger H, van Venrooij WJ, Voskuyl AE et al (2003) Polymyositis: an overdiagnosed entity. Neurology 61:316–321

    PubMed  Google Scholar 

  46. Punzi L, Betterle C (2004) Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine 71:275–283

    Article  PubMed  Google Scholar 

  47. Norden AG, Jackson RA, Norden LE, Griffin AJ, Barnes MA, Little JA (1997) Misleading results from immunoassays of serum free thyroxine in the presence of rheumatoid factor. Clin Chem 43:957–962

    PubMed  CAS  Google Scholar 

  48. Simmons-O’Brien E, Chen S, Watson R, Antoni C, Petri M, Hochberg M et al (1995) One hundred anti-Ro (SS-A) antibody positive patients: a 10-year follow-up. Medicine (Baltimore) 74:109–130

    Article  Google Scholar 

  49. Bohan A, Peter JB, Bowman RL, Pearson CM (1977) Computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. Medicine (Baltimore) 56:255–286

    CAS  Google Scholar 

  50. Airio A, Kautiainen H, Hakala M (2006) Prognosis and mortality of polymyositis and dermatomyositis patients. Clin Rheumatol 25:234–239

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

None

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Renming Hospital of Shiyan City, Hubei Yiyao College, 42 Chao Yang Lu, Shiyan, Hubei, 442000, People’s Republic of China

    Han Wang & Hong Li

  2. Department of Geriatrics, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People’s Republic of China

    Han Wang & Juelin Deng

  3. Department of Internal Medicine, Danjiang Hospital, 32 Renming, Shiyan, Hubei, 442000, People’s Republic of China

    Cui Kai

Authors
  1. Han Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cui Kai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juelin Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juelin Deng.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, H., Li, H., Kai, C. et al. Polymyositis associated with hypothyroidism or hyperthyroidism: two cases and review of the literature. Clin Rheumatol 30, 449–458 (2011). https://doi.org/10.1007/s10067-010-1570-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-010-1570-8

Keywords

Search

Navigation