| Objective To analyze the clinical characteristics of chronic hyperthyroidism myopathy before and during treatment by the changes of muscle strength,function and body composition.Method Hyperthyroidism patients as study group and health people as control group were divided by gender and age.The grip strength,pace and endurance was tested,body composition analysis was performed with dual-energy X-ray absorptiometry before and after treatment of hyperthyroidism.Result The study included 41 patients with hyperthyroidism as the study group(15 males and 26 females)for muscle strength,function and weight assessment before and after 3 month treatment by anti-thyroid drug.Healthy control group contained 50 people(25 males and 25 females).The recovery rate of hyperthyroidism was 100%after treatment in the study group.The mean value of male grip strength increased from 31.45±8.53kg to 40.62±4.80kg(p<0.01)before and after treatment,and the average value of female grip strength increased from 20.40±4.09kg to 23.38±3.68kg(p<0.01),it was significantly lower than the control group before treatment(p<0.01)and there was significant increase after treatment(p<0.01).After treatment,the grip strength of males was still lower than that of the control group(p<0.01),and there was no significant difference of grip strength of females between study and control group(p>0.05).The male pace changed from 1.03±0.07 m/s to 1.07±0.08 m/s(p<0.05),and the female changed from 0.99±0.10 m/s to 0.97±0.07 m/s(p=0.178)after treatment.Both were significantly lower than the control group(p<0.01).The skeletal weight of male patients increased from 1784±269g to 1824±293g(p<0.05),the whole body muscle weight increased from 40270±7533g to 4055017813g(p>0.05),and the limb muscle weight increased from 17455±4542g to 13192±1612g(p<0.01),the fat weight increased from 12400±2688g to 14552±2876g(p<0.01).Female body bone weight increased from 1433±340g to 1436±328g(p>0.05),body muscle weight increased from 32028±5260g to 32145±5170g(p>0.05),and limb muscle weight increased from 13017±2622g to 13192±1612g(p<0.01),fat weight increased from 14883±3356g to 16423±4183g(p<0.01).The age subgroup analysis based on the age of 40 years old showed that there was no significant increase in bone and muscle weight(p>0.05)and significant increase in fat weight(p<0.01)in middle-aged and elderly men.There was no significant difference in muscle weight(p>0.05)and increased fat weight(p<0.01).Taking the two standard deviations below mean of the control group as the diagnostic criteria for CTM,the diagnostic rate of grip strength was 63.4%,the pace diagnosis rate was 43.9%,and the skeletal muscle quality diagnosis rate was 31.7%.Taking Asian Working Group for Sarcopenia(AWGS)stand as diagnostic criteria for CTM,the diagnostic rate of grip strength was 31.7%,the pace diagnosis rate was 9.75%,and the skeletal muscle quality diagnosis rate was 68.8%Conclusion Patients with hyperthyroidism have decreased grip strength,pace and skeletal muscle mass.Anti-thyroid treatment can improve skeletal muscle strength and function at an early stage,but it can not increase muscle and bone weight.Early weight gain is mainly fat.The muscle and bone gain in middle-aged and elderly patients is worse than that of young patients.Objective To diagnose acute hyperthyroidism myopathy by bulbar paralysis symptom scores and analyze the clinical features of acute hyperthyroidism myopathy and to observe the effect of short-term application of glucocorticoids on the symptoms of medullary paralysis.Method Acute hyperthyroid myopathy was diagnosed by questionnaire containing bulbar paralysis symptom scores,Patients with acute hyperthyroidism myopathy was divided into glucocorticoids therapy group and glucocorticoids-free treatment group,compared with bulbar function changes by bulbar paralysis symptom scores.Result 25 ATM patients were diagnosed in 127 patients with hyperthyroidism.The patients with ATM had lower grip strength than those without ATM(p<0.01),and the patients with acute hyperthyroidism in men had more High T3,T4,FT3,and FT4 levels(p<0.01)were higher in women with acute hyperthyroid myopathy(p<0.01).There was no significant difference in pace and skeletal muscle mass between the ATM group and the no-TM group(p>0.05),hormone therapy and hormone-free treatment can achieve more than 90%remission rate,6 days before treatment,the remission rate is faster,there is no significant difference in remission rate after 6 days.Conclusion Patients with ATM have worse muscle function.Short-term glucocorticoid treatment can accelerate the recovery of medullary paralysis,but does not affect the 2-week remission rate.Objective Two hyperthyroidism patients with low potassium in the above study were further diagnosed by sequencing to try to find new hyperthyroidism sub-types.Method The blood samples of the study subjects were collected,and the mutation sites were detected by Next-generation sequencing(NGS),verified by the sanger method,and the family members of the study were tested according to the sequencing results.Result A new SLC12A3(16q13)homozygous variation for the first time,and patient was diagnosed as Gitelman syndrome.Further literature search found that all reported cases of hyperthyroidism complicated with Gitelman syndrome were from China and Japan,mostly with low potassium periodic paralysis as a clinical manifestation.Conclusion Gitelman syndrome combined with Graves disease is easily misdiagnosed as low-potassium periodic paralysis,which may be unique to East Asian populations. |
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