A patient with
Graves' disease associated with severe
muscle weakness who was finally diagnosed as
polymyositis by pathological examination of the muscle is reported. A 28-year-old women was incidentally found to have
hyperthyroidism when she consulted a hospital for the evaluation and treatment of
anemia in 1979. She was treated with
methimazole for approximately a month when she stopped the medication by herself. Approximately two yr later (Nov. 4, 1981) she consulted another hospital with complaints of palpitation and
muscle weakness. Diagnosis of
hyperthyroidism due to
Graves' disease and thyrotoxic
myopathy were made, followed by the treatment with radioiodine (4 mCi of 131I). She was further treated with
propylthiouracil (PTU). Four yr after the treatment, serum
thyroid hormone concentration declined to the lower level than normal and serum TSH concentration increased. She was subsequently treated with synthetic I-T4. Despite the fact she became euthyroid with the treatment,
muscle weakness as well as elevated concentrations of muscle
enzymes were not improved. Muscle biopsy was made in July 1983, and she was diagnosed as immune
polymyositis and treatment with
prednisolone and
cyclophosphamide in addition to PTU or I-T4, was started. With the treatment, serum LDH decreased to the normal range. However she still has
muscle weakness and serum concentrations of CPK and
aldolase are still in higher levels than normal range.