摘要
目的探讨和总结甲状腺功能减退性肌病(hypothyroidism myopathy,HM)的临床、肌肉MRI及病理表现,以减少漏诊和误诊。方法分析2例HM患者的临床表现、肌酶谱、甲状腺功能、肌电图、骨骼肌病理、大腿MRI表现及治疗随访,结合文献分析。结果 2例患者均为中老年,隐匿起病,亚急性进展性的肌无力,以双下肢近端为主,运动不耐受,无肌强直及假肥大;肌酶谱升高,游离T3、T4减低,促甲状腺素升高,两者存在相关性;肌电图可疑肌源性损害;肌肉MRI为臀肌和大腿后群肌肉萎缩及脂肪变性,无炎性水肿信号;肌肉病理为Ⅰ型肌纤维肥大,占优势,Ⅱ型肌纤维呈小角状和长条状萎缩。甲状腺激素替代治疗的预后良好。结论亚急性起病的中老年患者,出现轻度肌无力、运动不耐受、肌痛、假肥大等肌病症状,或为进展性肌炎样症状时,需常规的甲状腺功能检查,肌电图缺乏特异性,病理学可能为类神经源性改变,MRI具有一定的鉴别诊断及临床评估价值。
Objective To study the clinical, laboratorial, histopathological, imaging features of two cases of hypothyroid myopathy. Method Clinical manifestations, thyroid function, electromyography, muscle MRI, muscle biopsy and follow-up results were collected, and analyzed with the literature. Result These two patients were middle-age to old age and the onset of disease was insidious. Their common clinical manifestations included subacute progressive weakness in the proximal muscles, myalgia after sports and reduction in tendon reflex. The blood test showed an increase in serum concentration of CK and TSH, and a decrease in FT3 and FT4. The electromyography showed suspicious myogenic damage. Muscle histopathological findings were largely nonspecific, such as type Ⅰ fiber predominance and type 2 atrophy. The MRI revealed extensive muscular dystrophy and fatty filtration in the posterior group of thighs. Treatment of replacement therapy with L-T4 relieved the myopathic symptoms quickly. Conclusion When a patient presents with a subacute progressive weakness in the proximal muscles, the hypothyroidism should be consideration. Muscle histopathological findings may be nonspecific. The muscle MRI have a value of differential diagnosis and lesion assessment.
作者
金铭
陈海珠
许国荣
林晓丹
蔡乃青
刘信颐
林珉婷
王柠
王志强
JIN Ming;CHEN Haizhu;XU Guorong;LIN Xiaodan;CAI Naiqing;LIU Xinyi;LIN Minting;Wang Ning;WANG Zhiqiang(Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University,Fujian Key Laboratory of Molecular Neurology, Fuzhou, China)
出处
《中国神经精神疾病杂志》
CAS
CSCD
北大核心
2018年第3期144-148,共5页
Chinese Journal of Nervous and Mental Diseases
关键词
甲状腺功能减退性肌病
肌电图
核磁共振
病理
Hypothyroid Myopathy
electromyogram
muscle MRI
Muscle histopathology
