To assess the underlying mechanisms, we examined seven hyperthyroid women with Graves' disease before (Ht) and after (Eut) medical treatment and seven control subjects (Ctr). All subjects underwent a 3-h study in the postabsorptive state. After regional catheterization, protein dynamics of the whole body and of the forearm muscles were measured by amino acid tracer dilution technique using [15 N]phenylalanine and [ 2 H4]tyrosine. Before treatment, triiodothyronine was elevated (6.6 nmol/l) and whole body protein breakdown was icreased 40%. The net forearm release of phenylalanine was increased in hyperthyroidism (g ⅐ 100 ml Ϫ1 ⅐ min Ϫ1 ): Ϫ7.0 Ϯ 1.2 Ht vs. Ϫ3.8 Ϯ 0.8 Eut (P ϭ 0.04), Ϫ4.2 Ϯ 0.3 Ctr (P ϭ 0.048). Muscle protein breakdown, assessed by phenylalanine rate of appearance, was increased (g ⅐ 100 ml Ϫ1 ⅐ min Ϫ1 ): 15.5 Ϯ 2.0 Ht vs. 9.6 Ϯ 1.4 Eut (P ϭ 0.03), 9.9 Ϯ 0.6 Ctr (P ϭ 0.02). Muscle protein synthesis rate did not differ significantly. Muscle mass and muscle function were decreased 10 -20% before treatment. All abnormalities were normalized after therapy. In conclusion, our results show that hyperthyroidism is associated with increased muscle amino acid release resulting from increased muscle protein breakdown. These abnormalities can explain the clinical manifestations of sarcopenia and myopathy. hyperthyroidism; skeletal muscle; amino acids; stable isotopes; tracers; protein synthesis; protein breakdown; energy metabolism THYROID HORMONES HAVE PROFOUND metabolic effects, and chronic hyperthyroidism is characterized by increased energy expenditure (EE) with increased oxidation of protein, glucose, and lipids (19,28). Loss of muscle mass and subsequent sarcopenia are prominent clinical features of hyperthyroidism (27), and recovery of muscle mass and function is prolonged, lasting several months (24). Accelerated whole body protein catabolism has been demonstrated in experimental hyperthyroidism (16), but studies of whole body leucine kinetics in clinical and experimental hyperthyroidism have yielded inconsistent results. Studies of protein metabolism in hyperthyroid patients before and after treatment have suggested that the net protein catabolism is mainly because of depressed rates of whole body protein synthesis (7, 20) with low or normal rates of proteolysis. In experimental hyperthyroidism, increased rates of proteolysis with no change in protein synthesis rates have been reported (6, 16), whereas Tauveron et al. (35) found both increased proteolysis and synthesis. Thyroid hormones have both anabolic and catabolic effects; therefore, the net effect on protein metabolism may vary, and the above inconsistencies may relate to heterogeneity both of the hyperthyroid subjects, in terms of severity and duration of hyperthyroidism, and of the methods employed.The metabolism of muscle protein in hyperthyroid subjects has previously been described measuring urinary excretion or arteriovenous differences of 3-methylhistidine to estimate myofibrillar degradation, giving conflicting results. Some report no...