Cakir Mehtap, Samanci Nehir, Balci Nilufer, Balci Mustafa Kemal
Division of Endocrinology and Metabolism, Akdeniz University, School of Medicine, Antalya, Turkey.
Clin Endocrinol (Oxf). 2003 Aug;59(2):162-7. doi: 10.1046/j.1365-2265.2003.01786.x.
Thyroid dysfunction may cause musculoskeletal symptoms. We have evaluated the prevalence of adhesive capsulitis, Dupuytren's contracture, trigger finger, limited joint mobility and carpal tunnel syndrome in a series of patients with various thyroid diseases and differing levels of function.
Patients with euthyroid (diffuse and/or nodular) goitre, Hashimoto's thyroiditis, Graves' disease, toxic nodular goitre, toxic diffuse goitre and patients with goitre who had partial thyroidectomy were included in the study (n = 137). Neurological and musculoskeletal examinations were performed after a standardized symptom questionnaire. The prevalence of musculoskeletal problems was analysed with respect to thyroid function and thyroid autoantibody status.
Serum concentrations of free T3, free T4, TSH and thyroglobulin and thyroperoxidase antibodies were determined. Serum levels of creatine kinase, lactate dehydrogenase, calcium and phosphate along with erythrocyte sedimentation rate were measured to exclude other causes of musculoskeletal complaints.
When the study group (n = 137) was divided according to thyroid status, 30.6% (n = 42) were thyrotoxic, 16.8% (n = 23) had subclinical thyrotoxicosis, 28.5% (n = 39) were euthyroid, 7.3% (n = 10) had subclinical hypothyroidism and 16.8% (n = 23) were hypothyroid. Overall, adhesive capsulitis was found in 10.9% (n = 15), Dupuytren's contracture in 8.8% (n = 12), limited joint mobility in 4.4% (n = 6), trigger finger in 2.9% (n = 4) and carpal tunnel syndrome in 9.5% (n = 13) of the patients. The prevalence of adhesive capsulitis was highest in patients with subclinical thyrotoxicosis (17.4%); Dupuytren's contracture, limited joint mobility and carpal tunnel syndrome were commonest in hypothyroid patients (21.7%, 8.7% and 30.4%, respectively). Trigger finger occurred in 10% of patients with subclinical hypothyroidism. When these prevalences were analysed with respect to thyroid status, carpal tunnel syndrome was significantly more prevalent in the hypothyroid group (P = 0.004). When thyroperoxidase antibody-positive and -negative patients were compared, adhesive capsulitis negatively (P = 0.03, r =-0.18) and trigger finger positively correlated with (P = 0.03, r = 0.21) thyroperoxidase antibody existence.
These results demonstrate that musculoskeletal disorders often accompany thyroid dysfunction. In addition to the well-known observation that these disorders are common in patients with hypothyroidism, they are also observed in patients with thyrotoxicosis. Patients with thyroid dysfunction should be questioned for musculoskeletal complaints and referred to a specialist if necessary.
甲状腺功能障碍可能导致肌肉骨骼症状。我们评估了一系列患有各种甲状腺疾病且功能水平不同的患者中黏连性关节囊炎、掌腱膜挛缩症、扳机指、关节活动受限和腕管综合征的患病率。
研究纳入了患有甲状腺功能正常（弥漫性和/或结节性）甲状腺肿、桥本甲状腺炎、格雷夫斯病、毒性结节性甲状腺肿、毒性弥漫性甲状腺肿的患者以及接受了部分甲状腺切除术的甲状腺肿患者（n = 137）。在完成标准化症状问卷后进行神经和肌肉骨骼检查。根据甲状腺功能和甲状腺自身抗体状态分析肌肉骨骼问题的患病率。
测定血清游离T3、游离T4、促甲状腺激素（TSH）、甲状腺球蛋白以及甲状腺过氧化物酶抗体的浓度。测量血清肌酸激酶、乳酸脱氢酶、钙和磷水平以及红细胞沉降率，以排除肌肉骨骼症状的其他原因。
根据甲状腺状态对研究组（n = 137）进行划分时，30.6%（n = 42）为甲状腺毒症患者，16.8%（n = 23）为亚临床甲状腺毒症患者，28.5%（n = 39）为甲状腺功能正常患者，7.3%（n = 10）为亚临床甲状腺功能减退患者，16.8%（n = 23）为甲状腺功能减退患者。总体而言，10.9%（n = 15）的患者患有黏连性关节囊炎，8.8%（n = 12）患有掌腱膜挛缩症，4.4%（n = 6）有关节活动受限，2.9%（n = 4）有扳机指，9.5%（n = 13）有腕管综合征。黏连性关节囊炎在亚临床甲状腺毒症患者中患病率最高（17.4%）；掌腱膜挛缩症、关节活动受限和腕管综合征在甲状腺功能减退患者中最为常见（分别为21.7%、8.7%和30.4%）。亚临床甲状腺功能减退患者中10%出现扳机指。当根据甲状腺状态分析这些患病率时，腕管综合征在甲状腺功能减退组中明显更为普遍（P = 0.004）。比较甲状腺过氧化物酶抗体阳性和阴性患者时，黏连性关节囊炎与甲状腺过氧化物酶抗体存在呈负相关（P = 0.03，r = -0.18），扳机指与甲状腺过氧化物酶抗体存在呈正相关（P = 0.03，r = 0.21）。
这些结果表明，肌肉骨骼疾病常伴随甲状腺功能障碍。除了众所周知的这些疾病在甲状腺功能减退患者中常见外，在甲状腺毒症患者中也有发现。甲状腺功能障碍患者应被询问肌肉骨骼症状，必要时转诊至专科医生处。
