It is extremely rare that an inflammatory rheumatism reveals a hyperthyroidism. Only six observations have been described. We report a case of rheumatismal hyperthyroidism successfully treated with carbimazole and propranolol.
A 52 year-old woman presented with inflammatory rheumatismal pain predominating at the waist for the past six months and resistant to synthetic anti-inflammatories. Thyroid hormone analysis permitted diagnosis of hyperthyroidism. Initiation of treatment with carbimazole led to the rapid regression of the rheumatismal manifestations.
Hyperthyroidism is classically manifested by signs of hypercatabolism. Osteoarticular manifestations are dominated by humeroscapular periarthrosis. Rheumatismal hyperthyroidism is characterised by inflammatory rheumatismal pain evoking, as in our patient, a rhizomelic pseudo-polyarthritis. The outcome, whatever the anti-thyroid treatment, is always good. The physiopathological mechanisms are unknown. They may be due to an attack of the antibodies against the synovial and/or cartilage structures, or to the effect of propranolol.
It is important to underline the interest of thyroid hormone assay in cases of dubious etiological inflammatory rheumatism and/or resistant to classical treatments.