title: Reassessment of elicitation of myoedema in evaluation of overt hypothyroidism: A pilot study.
abstract: BACKGROUND
  There is a need to reassess the significance of myoedema in evaluation of overt hypothyroidism in the current day clinical practice. It is commonly checked for by flicking across the biceps belly expecting a transient mound at the points of tactile stimuli with mild pressure.
  
  
  OBJECTIVE
  To assess elicitation of myoedema in overt hypothyroidism (defined arbitrarily as TSH >50 mIU/L in primary hypothyroidism and fT4 <0.6 ng/dl in secondary hypothyroidism).
  
  
  RESULTS
  The 28 primary overt hypothyroid (OH) patients were divided into three groups as mild, moderate, and severe depending on TSH levels as those with 50-100, 100-150, and >150 mIU/L. Myoedema was elicited in 8 of 13 in the severe OH group, in 2 of 7 in moderate OH group and in 1 of 8 in the mild OH group. In the group of secondary hypothyroidism, myoedema was elicitable in one of two patients. The odds ratio for presence of both myoedema and clinical features of myopathy in a group of overt hypothyroid patients with TSH >150 mIU/L as compared to <150 mIU/L was 17.5. Similarly, the odds ratio for the presence of only myoedema was 6.4 while the odds ratio for presence of only clinical features of myopathy was 3.67. While the odds ratios involving presence of myoedema neared statistical significance, that with the presence of clinical features of myopathy alone did not.
  
  
  CONCLUSIONS
  Examination for eliciting myoedema is useful when evaluating a case of overt hypothyroidism.
authors.affiliation: Department of Endocrinology, JIPMER, Puducherry, India.
authors.forename: Karthik
authors.initials: K
authors.lastname: Balachandran
authors.forename: G
authors.initials: G
authors.lastname: Vignesh
authors.forename: D M
authors.initials: DM
authors.lastname: Mahesh
authors.forename: P
authors.initials: P
authors.lastname: Girish
authors.forename: C Sadishkumar
authors.initials: CS
authors.lastname: Kamalanathan
authors.forename: Jaya Prakash
authors.initials: JP
authors.lastname: Sahoo
authors.forename: Abdoul
authors.initials: A
authors.lastname: Hamide
keywords: Myoedema; hypothyroidism; myopathy
references.citation: Eur Neurol. 1992;32(3):130-3
references.pmid: 1592068
references.citation: Eur Eat Disord Rev. 2008 Sep;16(5):352-4
references.pmid: 18613002
references.citation: Br Med J. 1969 Aug 2;3(5665):299
references.pmid: 5800373
references.citation: Arch Intern Med. 1965 Dec;116(6):875-8
references.pmid: 5848221