Skeletal muscle is one of the major target organs for thyroid hormone. The muscles most commonly affected are those used during prolonged effort (slow-twitch muscles). One of the major clinical features is the shortening of the Achilles-tendon refer time in hyperthyroidism and its prolongation in hypothyroidism. Most of the peripheral effects of the thyroid hormones can be ascribed to the action of triiodothyronine (T-3), which is produced by de-iodination of thyroxine (T-4) in liver and kidney. From the plasma. T-3 is actively transported into skeletal muscle. The Ca2+ ATPase in skeletal muscle is responsible for removal of Ca2+ ions from the cytosol into the sarcoplasmic reticulum (SR) during relaxation, and the Na+, K+ ATPase in the plasma membrane is responsible for restoration of the membrane potential after excitation. The concentrations of Ca2+ ATPase and Na+, K+ ATPase in rat skeletal muscle have been shown to increase four- and 10-fold. respectively, in the transition from the hypothyroid to the hyperthyroid state. In humans. a linear correlation between the Na+, K+ ATPase concentration of skeletal muscle and the free T-4 index was established. Significant effects of T-3 on Ca2+ ATPase and Na+, K+ ATPase can be detected 24 h after a single injection. These effects are mediated by increased production of mRNA for the respective proteins. initialed by binding of T-3 to nuclear receptors. Passive fluxes of Ca2+. Na+ and K+ also show a significant rise after T-3 treatment. The increase in passive fluxes of Na+ and K+ can be detected before the rise in the concentration of Na+, K+ ATPase suggesting that T-3, in addition to its nuclear effects. may have a direct effect on the plasma membrane. Apart from their significance for muscle function in thyroid disease, the changes in Ca2+ ATPase and Na+, K+ ATPase will be important in other conditions where T-3 and T-4 levels show dramatic changes. i.e. during postnatal development. starvation and undernutrition. as well as in non-thyroidal illness (low-T-3 syndrome).