Therapeutic efficacy of glucocorticoids, ATP, and antithyroid drugs in acute thyrotoxic myopathy: evaluation using the acute thyrotoxic myopathy symptom score.

BACKGROUND

Acute thyrotoxic myopathy (ATM) is a relatively rare and severe complication of hyperthyroidism, mainly reported in individual cases and lacking standardized treatment protocols.

OBJECTIVE

This study evaluated the efficacy of glucocorticoids (GCs), adenosine triphosphate (ATP), and antithyroid drugs (ATDs) in treating ATM to guide clinical management.

METHODS

We retrospectively analyzed 42 ATM patients treated with GCs, ATP, and ATDs. The Acute Thyrotoxic Myopathy Symptom Score (ATMSS) was applied to evaluate efficacy at baseline (T0), day 7 (T7), and day 28 (T28) of treatment. Binary logistic regression was used to identify predictors of therapeutic efficacy, examining the impact of pre-treatment biochemical indicators and ATMSS on symptom relief (R) at T7 and complete remission (CR) at T28.

RESULT: ATMSS demonstrated significant improvement at both T7 and T28 (P < 0.001). R and CR rates differed among symptoms, with nasal reflux, dysphagia, and dyspnea showing markedly higher rates than dysarthria, gag reflex, and muscle weakness (T7: χ² = 30.89, T28: χ² = 36.71, both P < 0.001). Binary logistic regression analysis indicated that higher baseline dysarthria scores were associated with lower R rates at T7 (OR = 0.216, 95% CI = 0.056-0.836, P = 0.027), while more severe muscle weakness at T7 predicted lower CR at T28 (OR = 0.564, 95% CI = 0.323-0.984, P = 0.044).

CONCLUSION

The combination of GCs, ATP, and ATDs effectively alleviated the ATMSS in the short (7day) and medium (28day) term. However, recovery rates differ among symptoms. Specifically, dysarthria at baseline and muscle weakness at T7 showed significant predictive value for treatment outcomes.