Abnormalities of thyroid function can cause a wide array of muscle disorders. Hypothyroidism is associated with muscle cramps, pain, and stiffness, and proximal muscle weakness occurs in one-third of pts; the relaxation phase of muscle stretch reflexes is prolonged, and serum CK is often elevated (up to 10 times normal).

Hyperthyroidism can produce proximal muscle weakness and atrophy; bulbar, respiratory, and even esophageal muscles are occasionally involved, causing dysphagia, dysphonia, and aspiration. Other neuromuscular disorders associated with hyperthyroidism include hypoKPP, myasthenia gravis, and a progressive ocular myopathy associated with proptosis (Graves’ ophthalmopathy).

Parathyroid, adrenal, and pituitary disorders, as well as diabetes mellitus, can also produce myopathy. Deficiency of vitamin D is a rare cause of muscle weakness.