| Objective:To study the variation of the serum creatine kinase?CK?and t he clinical manifestations of limb myopathy in patients with hyperthyroidism d uring the therapy with propylthiouracil?PTU?and methimazole?MMI?.and pr obe the factors affecting the increase of serum CK and the clinical characteristic s of myopath,to guide clinical reasonable use of anti-thyroid drugs?ATDs?.Methods:The study subjects were 560 patients with hyperthyroidism who t reated in our hospital?110 cases treated with PTU and 450 cases treated with M MI?.The patients were trisected into the mild group?n=386?,the medium group?n=72?and the severe group?n=102?on the basis of the tandard of free thyroxine?FT4?or free triiodithyronine?FT3?before therapy.The initial daily dose of anti-thyroid drugs for the three groups was 150mg,200mg,300mg of prothiouracil,or 15mg,20mg,30mg of methimazole[1,2].Regularly reviewed the thyroid func tion and serum CK during treatment.and the muscle symptoms of the limbs we re evaluated at each subsequent visit.The dose of anti-thyroid drugs was appropr iately adjusted.The changes of serum CK level and the clinical characteristics of myalgia in hyperthyroidism patients during medication were observed,and patie nts were trisected into three groups according to the CK level,namely the CK no rmal group,the CK mildly elevated group and the CK severely elevated group.Results:?1?The comparison of different kinds of hyperthyroidism incidenc e of elevated serum CK.The incidence of elevated serum CK was8.3%?32/386?in the mild group and 20.8%?15/72?in the medium group and 20.6%?21/102?in the severe group.The incidence of elevated serum CK in the severe gr oup and in the mild group was higher than the moderate group?P<0.05?.but th e incidence of disease group and severe group serum CK elevated comparing is no statistical significance?P>0.05?.?2?Comparison of the increased incidence o f serum CK with different antithyroid drugs.The increased incidence of serum C K in MMI group was 12.2%,and that in PTU group was 11.8%.There was no st atistical significance between the two groups?P>0.05?.?3?Comparison the inci dence of myalgic symptoms in different hyperthyroidism conditions after treatm ent.There wasn't case with elevated CK in the mild group with myalgic.There were 4cases in the medium group and 9 cases in the severe group with myalgic.Compared with the mild group,the incidence of CK elevation with myalgic was higher in the middle group and the severe group.Patients in all three groups sho wed myalgic without CK elevation,and the incidence of myalgic without CK el evation was 0.85%in mild group,1.75%in moderate group,and 6.2%in severe group.Compared with the mild group,patients were more likely to have myalgi a in moderate group and severe group?P<0.05?.?4?Clinical features of myalgia.Myalgia can occur after anti-thyroid treatment in patients with or without elevat ed CK.However,patients with mild CK elevation did not have myalgia.It indic ates whether myalgia is related to the severity of hyperthyroidism.Fibromyalgia symptoms mainly occurs in the proximal limb,accidentally appear in the hindqu arters cadres such as abs,usually in a pull muscles position condition,patients of ten described as bad muscle fullness,acid sustainable for several minutes,after t he break but slowly returned to normal,may be accompanied by symptoms such as muscle cramps,muscle weakness,the symptoms of the person that weigh ser iously affect the daily life,in which one has the hospital make a diagnosis and gi ve treatment.?5?Comparison of hyperthyroidism and serum CK changes betwee n patients with muscle symptoms and those without muscle symptoms in patient s with elevated serum CK.Compared with the patients without muscle symptom s,the initial value and the peak value of Serum CK levels before treatment were higher than those without muscle symptoms,and the decrease rate of FT3 was g reater after treatment,the difference was statistically significant?P<0.05?.?6?Re lationship between elevated serum CK level and hyperthyroidism.Compared wit h normal group,the levels of FT3,FT4 in mild group and severe group were hi gher before treatment?P<0.05?.There was no significant difference in serum CK between the two groups?p>0.05?.?7?The time and outcome of serum CK elevati on related-antithyroid drugs.The levels of serum CK began to elevate in?110.67±107.22?days after treatment,and myalgia symptoms were relieved within 1to 3 weeks without any sequelae,the recovery of CK elevation was later,and the CK level gradually returned to normal after?57.06±28.49?days.?8?Factors af fecting the initial level of serum CK elevation.The initial level of serum elevatio n was negatively correlated with the age of patients,and positively correlated wi th the level of FT3 before treatment and the decrease of FT3 in the same period?P<0.05?.It was not related to gender,FT4 level before treatment,correspondin g FT3 and FT4 levels when CK increased,and the corresponding FT3 decline in the same period?P>0.05?.?9?Factors affecting the peak value of serum CK elevation.Serum CK elevation peak value is negatively correlated with patient gender?P<0.05?,and positively correlated with the initial value of CK elevation?P<0.05?.There was no significant linear correlation with age,CK,FT3,FT4 le vel before treatment,and the absolute value of FT3 and FT4 decline in the same period?P>0.05?.Conclusion:?1?Patients with hyperthyroidism can be increased serum CK levels after treatment with anti-thyroid drugs including MMI and PTU with an i ncidence of 12.1%.Among them,19.1%patients with increased CK show myalg ia,which can disappear within 1-3 weeks after reducing the dose of drugs,while the increased CK returns to normal with a slight lag.?2?Myalgia caused by AT Ds can occur in patients with or without CK elevation.Whether myalgia occurs i s related to the severity of hyperthyroidism.The initial value and peak value of CK elevation in myalgia patients with CK elevation are higher than without CK elevation.?3?The initial level of CK elevation may be related to the condition of hyperthyroidism serious and the reduce degree of FT3 after therapy,and has a negative linear correlation with the age of patients.There be likely to have no co rrelation with the following factors:the kind of ATDs,Gender,CK levels before treatment and the decrease levels of FT4 after ATDs treatment.?4?The peak le vel of CK elevation may be related to the condition of the initial level of CK el evation,and has a negative linear correlation with the gender of patients.There be likely to have no correlation with the following factors:the kind of ATDs,th e age,the condition of hyperthyroidism serious,levels of serum creatine kinase before therapy and the reduce degree of FT3 or FT4 after ATDs treatment. |
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