The Analysis Of Clinical Characteristics In 30 Patients With Hypothyroidism And Muscular Damage

BackgroundRecently,people pay more and more attention to thyroid disease,and the prevalence of hypothyroidism increases year by year.Hypothyroidism can affect the function of all organs and systems.Involving the striated muscle can cause hypothyroidism muscular damage.The type of hypothyroidism muscular damage that have reported including hypothyroid myopathy,hypothyroid heart disease,Rhabdomyolysis and HyperCKemia with mild clinical signs or Asymptomatic.In addition,because the muscle damage usually occurs in patients with long duration and serious conditions of hypothyroidism,so the muscle damage patients often merge other diseases caused by hypothyroidism.To analyze the clinical characteristics of' all kinds of hypothyroidism muscle damage and the diseases that they often merged is of great significance for the diagnosis and treatment of hypothyroidism muscle damage.ObjectiveTo explore the clinical characteristics,diagnosis and treatment of hypothyroidism whih muscle damage.and avoid the misdiagnosis and missed diagnosis of it.Methods1.Clinical data,including gender,age,symptoms,signs,Biochemical indicators and other laboratory examinations of 30 cases with hypothyroidism muscle damage that admitted to the Shandong provincial hospital during 2012 to 2016 were investigated by retrospective analysis.Six cases were diagnosed as hypothyroid myopathy,and 14 cases were diagnosed as hypothyroid heart disease,there were 5 cases exist at the same the above two kinds of disease.This group also includes one case of Rhabdomyolysis and 14 cases of HyperCKemia.2.Combined with the related literatures in recenetly years,and analyzed the clinical manifestations,diagnosis,treatment and prognosis of muscle damage that caused by hypothyroidism.Results1.The clinical manifestations of 30 casesThe main symptoms of hypothyroidism included weakness,afraid of the cold,limbs and facial edema,drowsiness,hoarseness,memory loss,weight gain,slow to respond,coarse skin,constipation,snoring and the physical examination mainly showed knee jerks.The thyroid stimulating hormone(TSH)of 30 patients were elevated significantly before treatment.The free triiodothyronine(FT3),free thyroxine(FT4)in 30 cases were obviously decreased.The 30 patients' biochemical indexes of creatine kinase(CK),creatine kinase-MB(CK-MB),lactate dehydrogenase(LDH).a-hydroxybutyrate dehydrogenase isoenzyme(HBDH)and aspartate aminotransferase(AST)were elevated,and the serum creatine kinase(CK)were elvated most significantly.Blood lipids increased in 22 cases,nine patients appeared lower hemoglobin,two patients with electrolyte disorder.Abdominal ultrasound revealed a fatty liver of' 12 patients,high blood pressure in 7 cases.There were one case with renal dysfunction and one case with obstructive sleep apnea.2.The clinical manitfstations in 6 cases with hypothyroid myopathyAll patients had proximal weakness,4 cases had painful muscles,3cases had cramps,2cases had muscle stiffiness,One case had masticatory muscle weakness,one case had muscle pseudohypertrophy,Electromyographic examination in 4 patients,three cases exhibited normal electromyography,one case with peripheral nerve damage.3.The clinical manifestations in 14 cases with hypothyroid heart diseaseIn all 14 cases.11cases had chest congestion.Electrocardiogram(ECG)showed ST-T change in 10 cases,5cases had sinus bradycardia,2cases had conduction block.Cardiac ultrasound showed pericardial effusion in 8 cases,large left ventricle in one case,chest x-ray showed heart amplification in one case.4.The clinical manifestations in one cases with RhabdomyolysisThe patient had marked limb muscle weakness,myalgias,numbness(may complicated with acute compartment syndrome),and had dark urine,high level of CK,severe hyponatremia and hypochloremia,leukocytosis,liver damage,positive urinary protein.5.The treatment and outcomeAll patients were given thyroid hormone replacement therapy in early diagnosis.All of the patients after treatment for 5 days the symptoms of low metabolic such as fatigue,cold intolerance start to improve..Treatment after 1-3 months the symptoms of muscle weakness in 5 cases have disappeared,began to improve,one case with muscle weakness persist,but the severity were reduced.The clical manifestation of chest tightness in 14 cases with hypothyroid heart disease were practically vanish.After thyroid hormone replacement,rehydration and basification ofurine,The condition of patient with Rhabdomyolysis were gradually improved.The serum levels of TSH,FT3,FT4,CK,AST,CK-MB,LDH,HBDH in 30 cases gradually returned to normal after about 1 to 2 months.6.Biochemical changes before and after treatmentBiochemical changes before and after treatment are given in Table 1.Serum FT3 and FT4 levels after treatment were significantly higher than those before treatment(P<0.01).The serum level of TSH was significantly decreased after treatment(P<0.01).After treatment The serum levels of CK,CK-MB,LDH,HBDH were significantly decreased(P<0.01),The difference was statistically significant.Conclusion1.The hypothyroidism muscular damage usually occur in the patients who were suffering long course and heavy hypothyroidism without effective treatment.The distinctive clinical manifestation of muscle damage includes the high levels of muscular enzyme,of which the CK elevated most significantly.The clinical manifestation of hypothyroid myopathy includes:proximal weakness,myalgias,cramps,muscle stiffiness,masticatory muscle weakness,pseudohypertrophy.The clinical manifestation of hypothyroid heart disease includes:chest congestion,Electrocardiogram(ECG)showed ST-T change,bradycardia,conduction block,Cardiac ultrasound showed pericardial effusion,large left ventricle,chest x-ray showed heart amplification.The clinical manifestation of Rhabdomyolysis includes:marked limb muscle weakness,myalgias,numbness(complicated with acute compartment syndrome),dark urine,the acute renal failure may occur in severe patients.The effect of thyroid hormone replacement therapy is good.2.The hypothyroidism muscular damage usually combined with other diseases such as hyperlipidemia,anemia,electrolyte disorder,high blood pressure,renal dysfunction,obstructive sleep apnea.3.The determination of serum muscle enzymes should be classified as hypothyroidism routine inspection.At the same time,patients with muscle damage symptoms associated with elevated muscle enzymes need testing thyroid function regularly.in order to early detection,early treatment,and avoid the happening of adverse consequences.