Thigh Weakness and Facial Numbness: Possible Causes and Solutions

Weakness in the front of the thigh and facial numbness?

Hello Doctor, I am actually unsure whether my condition is due to weakness in my thighs or my knees.
Since January of this year, I have felt something unusual in the front of my thighs; when I try to stand straight, my knees tend to bend involuntarily, and I also experience a sensation of weakness in my legs while walking, particularly in my right leg.
It feels as if something is obstructing the strength from being transmitted to the front of my thighs; if I force myself to stand straight or walk quickly, I have to exert effort, which results in soreness in the other muscles of my thighs by the end of the day (but there are no cramps, and my knees do not hurt).
Starting in February, I began to experience numbness in my cheeks (below the cheekbones and above the corners of my mouth); if I express more or talk more, I feel soreness, but if I remain expressionless and silent, I only feel numbness.
In early March, I consulted a neurologist, who performed repetitive nerve stimulation tests and checked for acetylcholine antibodies, all of which returned normal results.
Additionally, I had my potassium levels tested, which were also within the normal range.
I started receiving leuprolide injections for endometriosis in December of last year, so I have been taking calcium supplements.
In early January, I was diagnosed with hyperthyroidism (Hashimoto's thyroiditis) and have been taking methimazole, which is currently under control, and I am gradually reducing the dosage.
My doctor mentioned that if my blood tests are normal by the end of April, I can stop the medication.
I am also currently taking iron supplements to treat iron deficiency anemia.
Around mid-March, I switched to a higher dosage of calcium supplements, and after taking them for the first time, I noticed that the strength in my thighs returned, allowing me to stand straight without forcing it.
However, this effect lasted only about two hours before reverting, and subsequent doses of the same calcium supplement did not have any effect.
I would like to ask the doctor what might be causing my condition.
Thank you.

Niming, 20~29 year old female. Ask Date: 2016/03/31

Dr. Lan Shengxing reply Neurology

Dear Anonymous, there are too many intervening factors in your description, and more detailed information is needed to answer your question.

Reply Date: 2016/03/31

More Info

Your symptoms of thigh weakness and facial numbness are concerning and warrant a thorough investigation. Based on your description, it seems that you are experiencing a combination of lower limb weakness, particularly in the quadriceps, and facial numbness, which could be indicative of several underlying conditions.

Firstly, the weakness in your thighs, especially the sensation of your knees buckling and the requirement to exert extra effort to stand straight, could be related to neuromuscular issues. Given that you have undergone nerve conduction studies and tests for acetylcholine antibodies, which returned normal results, it may be less likely that you have a classic neuromuscular disorder such as myasthenia gravis. However, there are other possibilities to consider.

1. Peripheral Neuropathy: This condition can lead to weakness and numbness in the limbs. It can be caused by various factors, including diabetes, vitamin deficiencies (especially B vitamins), and exposure to toxins. Given your history of iron deficiency anemia, it may be worth investigating if there are any additional nutritional deficiencies contributing to your symptoms.

2. Thyroid Dysfunction: You mentioned having hyperthyroidism (Hashimoto's thyroiditis). Thyroid disorders can lead to muscle weakness and fatigue. As your thyroid levels are being managed, it’s essential to monitor how your muscle strength correlates with your thyroid hormone levels.

3. Electrolyte Imbalance: Although your potassium levels were normal, other electrolytes such as calcium, magnesium, and sodium can also impact muscle function. Since you have been taking calcium supplements, it may be beneficial to have a comprehensive metabolic panel done to check all relevant electrolytes.

4. Medication Side Effects: The medications you are taking for your conditions, including methimazole for hyperthyroidism and iron supplements, could potentially have side effects that impact muscle strength or nerve function. It’s crucial to discuss these with your healthcare provider to rule out any adverse effects.

5. Anxiety and Stress: Psychological factors can also manifest physically, leading to muscle tension and weakness. If you are experiencing significant stress or anxiety, it could contribute to your symptoms.

Regarding the facial numbness, which seems to be localized to the area between your cheekbone and mouth, this could be related to a few different issues:
1. Trigeminal Neuralgia: This condition affects the trigeminal nerve, which is responsible for sensation in the face. It can cause episodes of severe facial pain or numbness.

2. Neuropathy: Similar to the weakness in your legs, facial numbness could indicate a peripheral neuropathy affecting the facial nerve.

3. Cervical Issues: Sometimes, issues in the cervical spine can lead to nerve compression that affects both the upper and lower body.

Given the complexity of your symptoms, I recommend the following steps:
- Follow-Up with Neurology: Since you have already seen a neurologist, it may be beneficial to return with your new symptoms and discuss the possibility of further imaging studies, such as an MRI of the brain and cervical spine, to rule out any structural issues.

- Endocrinology Consultation: Given your thyroid condition, a consultation with an endocrinologist may provide insights into how your thyroid levels are affecting your overall health.

- Nutritional Assessment: A dietitian can help assess your nutritional intake and determine if there are any deficiencies that need to be addressed.

- Physical Therapy: Engaging in physical therapy may help improve your muscle strength and address any functional limitations you are experiencing.

In conclusion, your symptoms could stem from a combination of factors, including neuromuscular issues, thyroid dysfunction, medication side effects, or nutritional deficiencies. A multidisciplinary approach involving neurology, endocrinology, and possibly physical therapy will be crucial in diagnosing and managing your condition effectively. Please ensure you communicate all your symptoms clearly to your healthcare providers to facilitate a comprehensive evaluation.

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