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Hypothyroid Myopathy Differential Diagnoses

  • Author: Divakara Kedlaya, MBBS; Chief Editor: Stephen Kishner, MD, MHA  more...
Updated: Apr 07, 2015

Diagnostic Considerations

Myasthenia gravis

Myasthenia gravis has been associated with Graves disease and hypothyroidism.[27] Patients present with proximal muscle weakness that may be fatigable. Eventually, they can have dysphagia and respiratory distress.

Other metabolic, mitochondrial, and inflammatory myopathies

Glycogen metabolism deficiencies: These conditions are divided into dynamic and static deficiencies.

Dynamic myopathies: Manifestations of these disorders include exercise intolerance, pain, muscle cramps, and myoglobinuria.

  • Type V - Phosphorylase (McArdle disease)
  • Type VII - Phosphofructokinase (Tarui disease)
  • Type VIII - Phosphorylase B kinase
  • Type IX - Phosphoglycerate kinase
  • Type X - Phosphoglycerate mutase
  • Type XI - Lactate dehydrogenas

Static deficiencies: These disorders are associated with fixed weakness, but not with exercise intolerance or myoglobinuria.

  • Type II - Alpha-1,4 glucosidase (acid maltase)
  • Type III - Debranching
  • Type IV - Branching

Lipid metabolism deficiencies: These disorders can be accompanied by the following dynamic or static manifestations:

  • Carnitine palmitoyl transferase
  • Primary systemic/muscle carnitine deficiency
  • Secondary carnitine deficiency (eg, beta-oxidation defects, medications [such as valproic acid])
  • Purine metabolism deficiencies (eg, myoadenylate deaminase deficiency)

Mitochondrial myopathies

  • Pyruvate dehydrogenase complex deficiencies (eg, Leigh syndrome)
  • Progressive external ophthalmoplegia
  • Kearns-Sayre syndrome
  • Mitochondrial encephalopathy with lactic acidosis and strokelike episodes
  • Myoclonic epilepsy and ragged red fibers
  • Mitochondrial neurogastrointestinal encephalomyopathy
  • Mitochondrial depletion syndrome
  • Leigh syndrome and neuropathy, ataxia, or retinitis pigmentosa
  • Succinate dehydrogenase deficiency

Channelopathies are also differential diagnoses for myopathy.

Inflammatory myopathies are important differentials as well and may be difficult to differentiate from pure endocrine causes, including a heterogenous group of acquired, nonhereditary disorders characterized by muscle weakness and inflammation indicated by muscle biopsy.

Idiopathic inflammatory myopathies

  • Polymyositis
  • Dermatomyositis
  • Inclusion body myositis
  • Overlap syndromes with other connective tissue disease
  • Sarcoidosis and other granulomatous myositis conditions
  • Beh ç et syndrome
  • Inflammatory myopathies and eosinophilia
  • Focal myositis
  • Myositis ossificans

Bacterial infections

  • Staphylococcus aureus
  • Escherichia coli
  • Yersinia species
  • Legionella
  • Gas gangrene ( Clostridium welchii)
  • Leprous myositis
  • Lyme disease

Viral infections

  • Acute influenza or other viral infections
  • Retrovirus-related myopathies (human immunodeficiency virus [HIV], human T-cell leukemia virus type 1)
  • Hepatitis B and C
  • Postpolio syndrome

Parasitic infections

  • Trichinosis
  • Toxoplasmosis
  • Cysticercosis

Fungal infections

  • Candida species
  • Cryptococcus species
  • Sporotrichosis species

Differential Diagnoses

Contributor Information and Disclosures

Divakara Kedlaya, MBBS Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine; Medical Director, Physical Medicine and Rehabilitation and Pain Management, St Mary Corwin Medical Center

Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Colorado Medical Society, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.


Diana Echeverry, MD, MPH Assistant Professor, Department of Endocrinology, Charles Drew University of Medicine and Science

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Elizabeth A Moberg-Wolff, MD Medical Director, Pediatric Rehabilitation Medicine Associates

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

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