- 期刊
Rhambdomyolysis Induced by Hypothyroidism in a Patient with Hypopharyngeal Cancer: A Case Report and Review of the Literature
下咽癌治療後甲狀腺低下引起之橫紋肌溶解症
摘要
雖然甲狀腺低下的病人常有神經肌肉的症狀，甲狀腺低下造成的橫紋肌溶解症卻很少見，僅見於案例報告，並且通常合併有其他的加重因子：如劇烈運動或使用降血脂藥物等。本案例報告為一下咽癌病人在接受手術和放射線治療後產生甲狀腺低下並造成橫紋肌溶解症。此為一位41歲男性病患，本身有左側口腔癌和左側下咽癌。在接受全喉切除術、化療及放射線治療後約一年開始有肌肉疼痛的症狀。病人沒有受過嚴重肢體創傷、口腔咽喉處沒有局部壞死、也沒有服用可能造成橫紋肌溶解症的藥物。最近一次的核磁共振顯示腫瘤沒有局部復發的情形。實驗室檢查顯示肌酸磷酸激酶（CPK）升高至13034 IU/L（38-160 IU/L），同時有低血鈣（calcium 7.1mg/dl）（8.3-10.5mg/dl）和肌肝酸上升。進一步的檢查顯示甲狀腺低下及副甲狀腺低下，抗甲狀腺過氧化抗體為0.4 IU/mL（0-5.61 IU/mL）。補充甲狀腺素和鈣後，病人甲狀腺機能回復正常，肌肉疼痛改善，CPK值和肌肝酸亦回復至基礎值。若病人出現原因不明的橫紋肌溶解症，應想到是否有甲狀腺低下，仔細診斷並適當治療。
關鍵字
無資料並列摘要
Though neuromuscular involvement is common in hypothyroid patients, rhambdomyolysis is only seen in case reports and usually with precipitating factors such as strenuous exercise or statin. Here we reported a rare case of rhambdomyolysis induced by post treatment hypothyroidism in a patient with hypopharyngeal cancer. A 41 year-old male with left oral cancer and left hypopharyngeal cancer suffered from myagia about one year after he underwent total laryngopharyngectomy and concurrent radiochemotherapy. There was no major trauma, no local necrosis and he did not take medications which may induce rhambdomyolysis. Recent magnetic resonance imaging revealed no evidence of local recurrence. Lab data revealed high creatine phosphokinase (CPK) of 13034 IU/L (38-160 IU/L), hypocalcemia with calcium of 7.1 mg/dl (8.3-10.5 mg/dl) and deteriorated renal function. Hydration and urinary alkalization were given. Further investigation revealed overt hypothyroidism and hypoparathyroidism. The free thyroxin was ＜0.4 ng/dL (0.7-1.48 ng/dL) and the thyrotropin was 171 μIU/mL (0.35-1.94 μIU/mL). The thyroid peroxidase antibody was 0.4 IU/mL (0-5.61 IU/mL). After supplement of levothyroxin and calcium carbonate, the patient achieved euthyroid, his myalgia improved, the CPK level decreased to normal limit and the creatinine decreased to baseline. Hypothyroidism should be kept in mind and treat properly with patients suffering from unexplained rhambdomyolysis.
延伸閱讀
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