Retas miopatijos diferencines diagnostikos atvejis

2 lentelë. Idiopatinës uþdegiminës miopatijos, hipotireozës ir hipertireozës sukeltos miopatijos

diferencinë diagnozë (13)

Skydliaukæ

T

4

Kreatin-

Proksimaliniø

Raumenø

Miopatija

stimuliuojanèio

kiekis

fosfokinazës

raumenø

biopsijos

hormono kiekis

kiekis

silpnumas

rodmenys

Uþdegiminë

normalus

normalus

padidëjæs

vidutinis ar

uþdegiminiai

ryðkus

pakitimai

Hipotireozës

padidëjæs

sumaþëjæs

padidëjæs

daþniausiai

daþniausiai

sukelta

neþymus

normali

Hipertireozës

sumaþëjæs

padidëjæs

normalus

daþniausiai

daþniausiai

sukelta

neþymus

normali

A rare case of differential diagnosis of myopathy

Margarita Pileckytë

Clinic of Rheumatology, Kaunas University of Medicine, Lithuania

Key words: autoimmunic thyroiditis, hypothyrosis, myopathy.

Summary. Relationship among thyroid dysfunction and musculoskeletal symptoms has been known for

years. Autoimmunic thyroiditis is the most common cause of hypothyrosis. A patient who suffered from myopathy

secondary to autoimmunic thyroiditis and hypothyrosis is described in this article. Attention has been drawn to

proximal muscle weakness and general fatigue which is common in such cases. Significant elevation of muscle

enzymes is typical. Usually no specific signs can be found on muscle biopsy. Much efforts should be put to

distinguish myopathy secondary to hypothyrosis from polymyalgia rheumatica, polymyositis or myopathies

caused by other diseases. Similar data of literature are reviewed in the article.

Correspondence to M. Pileckytë, Clinic of Rheumatology, Kaunas University of Medicine, Eiveniø 2, 3007 Kaunas,

Lithuania. E-mail: [e-mail]

Margarita Pileckytë

MEDICINA (2003) 39 tomas, Nr. 5

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493

Literatûra

1. Sergent JS. Arthritis accompanying endocrine and metabolic

disorders. In: Ruddy S, Harris ED, Sledge CB, editors. Kelleys

Textbook of Rheumatology. 3rd ed. Philadelphia: Saunders

WB Company; 2001. p. 1581-3.

2. Waltuck J. Musculoskeletal manifestations of thyroid disease.

Bulletin Rheum Dis 2001;49:1-3.

3. O’Rourke KS. Myopathies in the elderly. Rheum Dis Clin

NA 2000;26:647-67.

4. Ohtsuka T, Yamakage A, Yamazaki S. Dermal mucinosis and

musculoskeletal symptoms simulating polymyositis as apre-

senting sign of hypothyroidism. Eur J Dermatol 1999;9:227-9.

5. Jiskra J, Limanova Z. Myopathy syndrome in undiagnosed

hypothyroidism.Vnitr Lek 2001;47:642-6.

6. Bhansali A, Chandran V, Ramesh J, Kashyap A, Dash RJ.

Acute myoedema: an unusual presenting manifestation of

hypothyroid myopathy. Postgrad Med J 2000;76:99-100.

7. Hochberg MC, Edwards CQ, Barnes HU, et al. Hypothyroi-

dism presenting as a polymyositis – like syndrome. Arthritis

Rheum 1976;19:1363-6.

8. Rodolico C, Toscano A, Benvenga S, Mazzeo A, Bartolone

S, Bartolone L, et al. Myopathy as the persistently isolated

symptomatology of primary autoimmune hypothyroidism.

Thyroid 1998;8:1033-8.

9. Finsterer J, Stollberger C, Grossegger C, Kroiss A. Hypothy-

roid myopathy with unusually high serum creatine kinase

values. Horm Res 1999;52:205-8.

10. Cruz MW, Tendrich M, Vaisman M, Novis SA. Electroneu-

romyography and neuromuscular findings in 16 primary

hypothyroidism patients. Arq Neuropsiquiatr 1996;54:12-8.

11. Anderson JR. Inflammatory muscle diseases: muscle

pathology. Rheumatol Europe 1996;25:55-6.

12. Wortmann RL. Inflammatory diseases of muscle and other

myopathies. In: Ruddy S, Harris ED, Sledge CB, editors.

Kelley’s Textbook of Rheumatology. 3rd ed. Philadelphia:

Saunders WB Company; 2001. p. 1273-90.

13. Spencer RT. Inflammatory muscle disease. In: West SG,

editor. Rheumatology secrets. Philadelphia: Mosby; 1997.

p. 141-6.

14. Sansone V, Griggs RC, Moxley RT. Hypothyroidism unmas-

king proximal myotonic myopathy. Neuromuscul Disord

2000;10:165-72.

15. Ghilardi G, Gonvers JJ, So A. Hypothyroid myopathy as a

complication of interferon alpha therapy for chronichepatitis

C virus infection. Br J Rheumatol 1998;37:1349-51.

16. Lin RT, Liu CK, Tai CT, Lai CL. Hypothyroid myopathy-

pathological and ultrastructural study. Kaohsiung J Med Sci

2000;16:68-75.

17. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen

WH. Neuromuscular findings in thyroid dysfunction: a

prospective clinical and electrodiagnostic study. J Neurol

Neurosurg Psychiatry 2000;68:750-5.

Straipsnis gautas 2003 04 05, priimtas 2003 05 19

Received 5 April 2003, accepted 19 May 2003

Retas miopatijos diferencinës diagnostikos atvejis

MEDICINA (2003) 39 tomas, Nr. 5