Indian Journal of Medical Biochemistry

Register      Login

VOLUME 23 , ISSUE 2 ( May-August, 2019 ) > List of Articles

RESEARCH ARTICLE

Study of Serum Creatine Kinase and Lactate Dehydrogenase to Assess Muscular Involvement in Hypothyroidism

Reena R, Manjula KS, Priyadarshini KS, Usha SMR, HV Shetty

Keywords : Creatine Kinase (CK), Hypothyroidism, Lactate Dehydrogenase (LDH), Thyroid stimulating hormone (TSH).Thyroxine (T4), Triiodothyronine (T3)

Citation Information : R R, KS M, KS P, SMR U, Shetty H. Study of Serum Creatine Kinase and Lactate Dehydrogenase to Assess Muscular Involvement in Hypothyroidism. Indian J Med Biochem 2019; 23 (2):273-277.

DOI: 10.5005/jp-journals-10054-0103

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background: Hypothyroidism is one of the most commonly occurring endocrine disorders, worldwide. The disorder is associated with a wide range of muscular involvement varying from myalgia to true myopathy. Biochemical parameters such as serum Creatine Kinase (CK), a sensitive marker of muscle damage and serum Lactate Dehydrogenase (LDH), a general marker of tissue damage can be measured to assess the muscular involvement in hypothyroidism. In this study serum CK and LDH activities to assess the muscular involvement in hypothyroidism and to evaluate their relationship with T3, T4 and TSH. Materials and methods: Fifty, clinically diagnosed hypothyroidism patients with symptoms suggestive of muscle involvement were taken as cases and fifty sex and age matched, apparently healthy volunteers with normal thyroid function tests (TFT) were taken as controls. Biochemical estimations of triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), serum CK and serum LDH were done. Results: T3, T4 levels and serum CK and LDH activities were within the reference range in both the study groups. In seven cases high TSH with low T4 values were observed. Significant difference in serum CK and LDH activities were observed in these seven cases compared to rest of the forty-three cases. Even though there was no significant difference among the study groups (cases and controls), a weak positive correlation of CK, LDH with TSH levels and weak negative correlation with T3 and T4 levels were observed. Conclusion: Hormone replacement therapy shall be optimized to treat muscular involvement if serum CK and LDH activity is found to be elevated with low T4 levels, where as normal serum CK and LDH activity with normal T4 levels indicates that the thyroid treatment is optimized (serum T3 and T4 levels has come to the reference range though TSH is mildly elevated) and if the subject is still complaining of muscular symptoms, then other underlying causes for muscular involvement shall be ruled out.


PDF Share
  1. Ambika Gopalakrishnan Unnikrishnan, Usha V Menon. 2011.” Thyroid disorders in India: An epidemiological perspective”. Indian Journal of Endocrinology and Metabolism.15:6:78-81
  2. Lange.2006.” Lange Pathophysiology”. Chapter 20. Thyroid Disease. The McGraw-Hill Companies.
  3. Saima Mushtaq, Mona.A.Tilak, Malik Rameez Rashid, Sarita A. Shinde, Pradnya J.Phalak. 2014. “Biochemical evaluation of myopathy in Patients of hypothyroidism”. Indian Journal of Basic and Applied Medical Research. 3(2); 364-372.
  4. Khaleeli AA, Gohil K, McPhail G, Round JM, Edwards RHT. 1983. Muscle morphology and metabolism in hypothyroid myopathy: effects of treatment. J Clin Pathol. 36:519-526.
  5. Sinclair C, Gilchrist JM, Hennessey JV.2005. Muscle carnitine in hypo and hyperthyroidism. Muscle Nerve. 32(3):357-59.
  6. N P Singh, S Anuradha and S K Agarwal.2001.” A young woman with muscle weakness”. Postgrad Med J.; 77:266–285.
  7. HS Kiran, KA Sudharshana Murthy, AN Aparna 2011. “A young lady with swelling and stiffness of calf muscles”. Indian J Endocrinol Metab;15(2): 130-131.
  8. Hypothyroidsm symptoms linger despite of medication. ScienceDaily. https://www.sciencedaily.com/releases/2016/10/161012132038.htm
  9. Mary Shomon. 2018. “Understanding muscle pain and weakness in thyroid disease”. Thyroid Disease. https://www.verywell.com.
  10. Hekimsoy Z, Oktem IK. 2005. Serum creatine kinase levels in overt and subclinical hypothyroidism. Endocr Res. 31(3):171-5.
  11. KMDS Panag, Gitanjali, Sudeep Goyal. 2012. Evaluation of Creatine Kinase as a Diagnostic Tool for Thyroid Function. Indian Journal of Clinical Practice. 23(4);221-223.
  12. ArchanaPrakash, AK Lal, KS Negi.2007.” Serum Creatine Kinase Activity in Thyroid Disorders”.JK Science. Vol.9, No.1.
  13. Raju Pandey, Suresh Jaiswal, Jay Prakash Sah, Krishna Bastola, Subadhra Dulal. 2013. “Assessment of Serum Enzymes Level in Patients with Thyroid Alteration Attending Manipal Teaching Hospital, Pokhara”. Research and Reviews: A Journal of Life Sciences. 3(1): 1-9.
  14. Rekha Nanjundasetty Hemavathi, Anilkumar Hanumanthaiah. 2016. Evaluation of Serum Creatine Kinase Levels in Patients with Hypothyroidism. J. Evolution Med. Dent. Sciences. 05(35); 2053-2055.
  15. R. Shanti, M. Vijayalakshmi, R. Mahalakshmi. 2017. Creatine kinase & lactate dehydrogenase activity in patients with hypothyroidism. International Journal of Clinical Biochemistry and Research. 4(2):182-186.
  16. Hartl E, Finstere J, Grossegger C, Kroiss A, Stolleberger C. 2001. “Relationship between thyroid function and skeletal muscle involvement in subclinical and overt hypothyroidism”. Endocrinologist. 11:217-21.
  17. DA McGrowder, YP Fraser, L Gordon, TV Crawford, JM Rawlins. 2011. “Serum Creatine Kinase and Lactate Dehydrogenase activities in patients with thyroid disorders”. Niger J Clin Pra. Vol.14: 4: 454-459.
  18. P. D. Griffiths.1965.” Serum enzymes in diseases of thyroid gland”. J. Clin.Path.18, 660.
  19. Divakara Kedlaya. 2015. “Hypothyroid myopathy” emedicine.medscape.com/article/313915-overview.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.