Muscular disorders can occur in hyperthyroidism. These include thyrotoxic myopathies and thyrotoxic periodic paralysis. Thyrotoxic myopathies are the commonest manifestation, and usually affect the proximal muscles. Occasionally, these myopathies may be more localized in nature, and several examples of discrete involvement, for instance bulbar paralyses and diaphragmatic weakness have been reported in medical literature. Thyrotoxic periodic paralysis is an acute severe form of muscle weakness and declining potassium levels that is associated with thyrotoxicosis. In addition, Graves 'Ophthalmopathy, which involves the extra-ocular muscles, is associated with, but not causally linked to thyroid hormone excess. Finally, the prevalence of myasthenia gravis is higher in subjects with thyrotoxicosis. This article will focus on the spectrum of muscular involvement seen in subjects with thyrotoxicosis.

Thyroid disorders are a common platform where endocrinology, surgery and pathology departments need frequent interaction. We report four challenging thyroid cases that were diagnosed post operatively after histopathological examination are quite uncommon and challenging for a clinician involved in thyroid practice. Our first case is a patient for whom functioning papillary thyroid carcinoma was diagnosed, had multinodular goiter and features of hyperthyroidism with histopathological changes of papillary thyroid carcinoma and rest of the gland was normal. Another case of large goiter with obstructive symptoms with anasarca and proteinuria underwent emergency surgery and was diagnosed as amyloidosis of thyroid on basis of gross appearance and histopathological changes. Solitary fibrous tumor and lymphangioma of thyroid gland were two other rare cases that were diagnosed after diligent histopathological work-up. Pathologists experienced in thyroid diseases can be of great help in managing unusual thyroid lesions. These are rare conditions and they posed a management challenge till final diagnosis was achieved. Pathologists with awareness about such entities, in close interaction with the treating physician and surgeon, can contribute a lot in diagnosing such unusual conditions.

There are articles describing the various cellular effects after a high dose I 131 therapy, which serves as the first line of management in postoperative cases of differentiated thyroid carcinoma. We aimed to study the cytotoxic effects of a low dose ^1S1 I therapy used as treatment modality for hyperthyroid patients. Peripheral blood lymphocytes from a group of 20 patients, who received ^1S1 I sodium iodide solution orally, were studied for the presence of Chromosomal Aberrations (CA) and Micro Nucleus (MN) using micronucleus assay. The study was conducted using blood samples of such patients drawn prior to the treatment, on 7 ^th day and 30 ^th day after the treatment. The results indicate a positive relationship between dose, CA and MN frequency. A statistically significant increase in CA and MN frequency in 7 ^th day post therapy and a decrease in mean levels of CA and MN at 30 ^th day post therapy were observed when compared to pretherapy. This study showed that the cytogenetic damage induced by a low dose beta emitter like ^1S1 I is minimal and reversible.

Non thyroidal illness syndrome is used to describe alterations in thyroid function in various clinical situations and is cytokine mediated. We report a case of an 65 year old male with cough and low grade fever for 6 months. He had right side Hydro pneumothorax, exudative pleural effusion, high ESR, leucocytosis, transaminitis, prerenal azotemia and stress ulcers in stomach. His thyroid function showed low TSH and low normal freeT4. A technetium pertechnectate ("'"Tc) scintiscan of the thyroid was performed which showed absent uptake. Though not a standard indication for thyroid scintigraphy, NTIS is encountered quite frequently in clinical practice, and hence it is pertinent to discuss this well documented case.