Preprint version - When Severe Hypothyroidism Mimics Neuromuscular Diseases: A Case Supporting Outpatient Management in Modern Endocrinology

<p dir="ltr"><i>This is the preprint version of the published manuscript:</i></p><p dir="ltr"><b>Acanfora, M., Presciuttini, B., Benazzi, D., Pulcina, A., & Pagani, M. (2025). When Severe Hypothyroidism Mimics Neuromuscular Diseases: A Case Supporting Outpatient Management in Contemporary Endocrinology. In Cureus (published, Vol. 17, No. 8). Cureus.</b> <a href="https://doi.org/10.7759/cureus.91097" target="_blank"><b>https://doi.org/10.7759/cureus.91097</b></a></p><p dir="ltr"><i>Abstract</i></p><p dir="ltr"><b><i>Background</i></b><i>: Severe hypothyroidism may present with symptoms similar to those of primary</i><br><i>neuromuscular or acute neurological disorders, resulting in diagnostic delays and potentially</i><br><i>unnecessary hospitalizations.</i><br><b><i>Case presentation</i></b><i>: A 40-year-old man arrived at the emergency department (ED) because of postural instability, diplopia, myalgia, and elevated creatine kinase (CK), suggestive of a neuromuscular disorder. Labs revealed thyrotropin (TSH) levels over 170 μU/mL and suppressed free thyroxine (fT4). Despite severe biochemical parameters, clinical stability allowed for outpatient management with levothyroxine administration and endocrinological follow-up.</i><br><b><i>Discussion</i></b><i>: The case mimicked inflammatory myopathy or brainstem stroke, but the absence of ‘red flags’ allowed for safe outpatient treatment. Literature confirms that hypothyroidism can present with neurologic signs and that structured outpatient pathways are effective.</i><br><b><i>Conclusion</i></b><i>: This case highlights the importance of recognizing endocrine causes in neuromuscular presentations and supports outpatient management models for stable hypothyroid patients.</i></p><p dir="ltr"><br><b><i>Keywords</i></b><i>: hypothyroidism; myopathy; neuromuscular disorders; subacute neurological disorders;</i><br><i>outpatient management; sustainability of the healthcare system.</i></p>