Abstract
We report the case of diabetic amytropathy accompanied by Graves' disease. A 75-year-old man suffering gait disturbance in December 2001 gradually became unable to walk without a cane by October 2002, and could no longer walk unaided in April 2003. When seen in May 2003, we recognized marked thigh-muscle atrophy but not sarcitis because his muscle-deviated enzymes were normal and symptoms in MRI suggested muscle inflammations. An electromyogram of his atrophied thigh muscles showed no apparent abnormality. Because his nerve conduction study demonstrated prolonged distal potency time in the bilateral thigh nerves and peripheral neuropathy was shown in peroneotibial nerves, we concluded that thigh-muscle atrophy was due to nerve disturbances. We diagnosed him with diabetic amytropathy because of no conduction nerve block, localized thigh-muscle atrophy, poor diabetic control and normal thyroid function. We administered insulin injection, and he became able to walk unaided thanks to good diabetic control.
We recognized Gowers' symptom, palpitation, and finger tremors. His laboratory examination showed that TSH was suppressed at below 0.002 μU/l, and that free T3 was elevated at 16.2 pg/ml, free T4 at 5.7 ng/dl, TRAb at 42.0% and TSAb at 518%. He was diagnosed with Graves' disease, so we administered antithyroid drugs. Previous reports showed that one possible cause of diabetic amytropathy is immunological abnormality, suggesting that our case had autoimmune abonormality due to complications of autoimmunothyroid disease.
