Demosthenes. Bouro. M.D.,. F.C.C.P. To investigate respiratory muscle strength in patients with hypothyroidism, global respiratory muscle strength was.
Respiratory muscle strength in hypothyroidism. N M Siafakas, V Salesiotou, V Filaditaki, N Tzanakis, N Thalassinos and D Bouros Chest 1992;102;189-194 DOI 10.1378/chest.102.1.189 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/102/1/189
Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1992by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692
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Respiratory Muscle Hypothyroidism* Nikolaos Vassiliki
M. Siofaka Filaditaki,
Nikolaos
Thalassino
To investigate
M.D., Ph.D., M.D.; Nikolaos M.D.;
respiratory
muscle
assessed
by measuring
Psmox efforts. T4, and TSH
Maximum
were
replacement
measured
were
made
therapy
with
Measurements
FC.C.P; Tzanaki
Vassiliki M.D.;
Demosthenes
strength
in patients
in 43 hypothyroid
before
with
was and T3,
patients.
that the mean value of Pimax and Psmax increased after treatment. Significant change was found in the mean value ofVC, FEV1, and FVC after treatment but not in the FEV1/ FYC ratio. A highly statistically significant linear relationship was found between Pimax and TSH and between
I
is well
known
symptoms Dyspnea, breathing,
that can
airway reduced
hypercapnia,
and ‘
inspiratory
and
patients.7 Recently,
obstruction, responses respiratory
severe
patients
has been
reduction
shown
are studied
with
were
before
that
reduced in very
in few
reported
study
thyroid
to
evaluate
been
AND
METHODS
43 hypothyroid iatrogenic
patients,
myxedema.
15 with All
patients
idiopathic were
(primary) ambulatory
papillary
study.
Four
therapy
and
T3 and affects
weakness
is
Respiratory and expira102:169-194)
had
ing the patients
are shown
and TSH
were
Only
6.4
they
excluded
after
episodes
percent])
with
when
the
the
examination
Measurements technique
for T3 they
were
and heart beta
to
and
was
ofT4,
T3,
(Amerlex
The
T3
normal
52 to 196
values
ng/dl;
or those
and
illness.
Patients
their
were
who
smoking
during
related were
ofdiagnosis
disease
made long (n = 14; [33
smoked
habits
symptoms
on drugs
or metastatic
All measurements
study.
time
failure
blockers)
measurements
at the
any treatment,
patients
data regardof hypothyroid-
diagnosis
Sorin).
(eg,
any significant
performed
one year replacement
for the
clinical
and TSH,
myxedema
function
not change
show
a a
to 10 pAJ/ml.
of febrile
or sputum) were
0.6
from
did
not
mg/dl;
to 12.5 were
muscle
1. The
T4, T3, and TSH.
England,
patients
in order
and
in had
at least
Anthropometric
by radioimmunoassay
Amersham,
were
did
made
stopped
history
had
measurements,
disease. in Table
was made by medical confirmed by measuring ism
myxedema
carcinoma
before
been
Department
iatrogenic
thyroid
weeks
for metastatic
affecting
function.
Punax hypothyroidism
Endocrinology
with
be investigated
re-
respiratory
that
the
Patients
for
this
for TSH
volumes in a large number patients before and three We particularly aimed to between respiratory mus-
between
strength and that this thyroid hormone levels. present in both inspiratory reversible with treatment. (Chest 1992;
from
order.
for T4 were
was increased
Controversial data have the VC in hypothyroidism.9 this
and
which
as
conclude
recruited
(thyroxine)
these
as well
Pdi = transdiaphragmatic pressure; Pimax maximum static expiratory pressure; Pimaxmaximum static inspiratory prossure; RVresidual volume; T3triiodothyronine; T4thyroxme; ThC total lung capacity; TSllthyroid-stimulating hormono
thyroidectomy
Data
We studied 28
been
in Pdi has been
myxedema,
MATERIALS
and
has
it
TSH
and T3. We respiratory muscle linearly related to muscle weakness is tory muscles and is
consecutive
are among
pressures
and
PEmax PEmax
and
sleep-disordered to chemical stimuli,
In addition,
with
conducted
strength
Clinical
respiratory
hypothyroidism.
failure
expiratory
muscle strength and lung of ambulatory hypothyroid months after treatment. investigate the relationship cle
in
F.C.C.P
and T4,
after treatment.8 ported concerning We
of clinical
present
but this
hypothyroidism,
in three
a variety
be
M.D.;
M.D.,
amd three months after The results showed
thyroxine.
in Saksiotou,
Bouro
respiratory muscle strength mouth pressure during Pimax pressures, VC, FEV1, FVC,
global
hypothyroidism,
and
Strength
the
study
to smoking made.
and
(cough
Measurements
ofhypothyroidism,
before
therapy with T4. Three months after therapy, only 21 patients became euthyroid as estimated by the values ofTSH. The rest had a reduced value of TSH but the value did not reach the normal range. Vital capacity, FVC, and FEV, were measured by a dry spirometer (Vitalograph, Buckingham, England), and the FEV,/FVC ratio was calculated. All volumes
and
were
predicted
three
corrected
values,
months
after
to BTPS
and
the
and
replacement
expressed
FEV1/FVC
ratio
as a percentage was
of
expressed
as
a
percentage of FVC.’#{176} *Frnm
the
Department
ofThoracic
Medicine,
University
of Crete
Medical School, Heraklion, Crete, (Drs Siafakas, Tzanalds, and Bouros); and the Department ofThoracic Medicine (Drs Siafakas, Salesiotou, and Filaditaki) and Endocrinology (Dr Thalassinos), Evangelismos Hospital, Athens, Greece. Preliminary results of this study were presented at the 22nd Annual Meeting of SEPCR in Antwerp, Belgium, in 1987. This article was presented at the Annual Meeting, American Thoracic Society, 1991, Anaheim, Calif. Manuscript received June 13; revision accepted October 2. Reprint requests: Dr. Siofaka Department of Thoracic Medicine, University Hospital, Heraklion, Grcece 71110
Global Pimax
respiratory
RV and clip.
Pmax
and
Pamax
Their
was
near
mouths
maximum
muscle mouth
a metal
TLC.
were
pressures
strength The
Patients
connected
by a hard,
cylinder
was
pressures.
15 cm
long
were
assessed
Pimax
by
seated
and
rubber
with
piece.
an internal
The
mm
Paris),
one
Hg) and the other
measuring
negative
pressures
positive
pressures
(from
CHEST/102/1/JULY,1992
Downloaded from chestjournal.chestpubs.org by guest on July 10, 2011 © 1992 American College of Chest Physicians
near a nose
instrument
of 3 cm oral pressure
diameter
and a small leak (2 mm) at the distal end to minimize artifacts. The distal end was connected to two pressure
(Maxant,
wore
that measured
to the instrument stiff
measuring
measured
was
transducers
(from 0 to + 350
0 to mm
-
200 Hg).
189
Table
Data
1 -Anthropometric
Mean
and
Changes
in Weight
after
Treatment
(Mean
Sex
hypothyroidism
\%ight
No.
Male
Idiopathic
15
5
10
57.6±9.4
Jatrogenic
28
6
22
53.0±
Total
43
11
32
. . .
. . .
*No
significant
difference
tStatistically
manometers
Both
maximum Efforts the
maintained
used
mean
weight
rested
enabling
for at least was
less
when
1 s. These
efforts
5 percent
and
than
at
before
the
us to read
maximum
82.6±12.3
129.3±24.3
Before
160±7*
75.4±
121.5±20.7*
Before
± 7.8
were the
recorded
after
was
Analysis are presented
Data to
mean
values
complete paired
of the
t test.
value
statistically
data
two
before The
relationships. indicate
as mean
evaluate
groups. and
least
squares
method value
less
mean
patients
was
H20 with
Student
was than
t test
was
between
in mean
treatment
the
values
were
evaluated
used
to calculate
0.05
was
of the by
the
linear
value
considered
to
U LTS
Pimax
83 ± 25 cm
H20
after three months thyroxine. This change
1 SD
before
and
)
for
all
43
in the
PEinax
mean value of 115 ± 32 after mean
±
SD
1
of
of patients
1 . Table
2 shows
ratio,
as well and
before
After
thyroid
treatment significant
change
ment
shown
mean
and
iatrogenic)
value
levels and
of all patients (p
