Hypothyroid Myopathy-Pathological and Ultrastructural Study

甲狀腺功能低下之肌肉病變─肌肉之病理及超顯微結構變化之研究

林瑞泰(Ruey-Tay Lin) ； 劉景寬(Ching-Kuan Liu) ； 戴志達(Chih-Ta Tai) ； 賴秋蓮(Chiou-Lian Lai)

《The Kaohsiung Journal of Medical Sciences》 16卷2期 (2000/02) Pp. 68-75

https://doi.org/10.6452/KJMS.200002.0068

摘要

本研究主要探討十七位罹患甲狀腺功能低下症患者，其於甲狀腺素治療前後之肌肉病變的變化。臨床上，我們使用修改版之肌力量表來評估罹病患者肌肉病變的嚴重度。患者定期接受甲狀腺功能之測定、血清肌酐酸(serum creatine kinase)濃度及肌電圖檢查(electromyography)直到肌肉活體切片採樣。平均治療追蹤期間為1.8年。由研究結果顯示1)甲狀腺功能低下患者之光學顯微肌肉病理變化中，肌纖維萎縮及含中央核的肌纖維之增多可證實臨床肌病變之存在。2)甲狀腺素治療後，在超顯微肌肉病理研究方面，不正常的肌肝糖(glycogen)沈積與肌肉病變之臨床嚴重度密切相關，而且也隨著甲狀腺素治療而逐漸改善；但是，粒腺體的不正常與肌肉病變之嚴重度並無統計學上有意義的相關，它可能是晚期發病或是長期甲狀腺功能低下症患者之永久性變化。3)反覆之肌肉切片檢查，對於甲狀腺功能低下症肌肉病變之研究並非必須，但對於經甲狀腺素治療後仍伴隨肌肉病變表徵之特定患者，仍有助於釐清其療效。

並列摘要

Seventeen patients with hypothyroid myopathy were studied before and after thyroxine (T4) treatment. The severity of clinical myopathy was assessed with the aid of a modified rating scale. Laboratory findings including thyroid function, serum creatine kinase (CK), and electromyography were assessed at regular time intervals until a final muscle biopsy was performed. The average period of follow-up was 1.8 years. The authors emphasize: 1) in skeletal muscle pathology of hypothyroidism, the fiber atrophy and increased central nuclear counts are evidence of clinical myopathy during thyroxine treatment; 2) in ul. trastructural pathology, the abnormal glycogen accumulation accounts largely for clinical severity and its ongoing resolution is parallel to steady amelioration following T4 therapy, while mitochondrial abnormalities are insignificant in clinical correlation and probably become permanent in some cases with prolonged hypothyroidism; and 3) serial needle biopsies of skeletal muscle are impractical for long-term study of hypothyroid myopathy, but they may be reserved for those patients with a sustained myopathic complaints on T4 therapy.

並列關鍵字

hypothyroid myopathy ； mitochondrial abnormality ； glycogen deposit