Advertisement

Journal of Endocrinological Investigation

, Volume 40, Issue 10, pp 1099–1106 | Cite as

Physical performance in newly diagnosed hypothyroidism: a pilot study

  • D. Gallo
  • E. PiantanidaEmail author
  • G. Veronesi
  • A. Lai
  • L. Sassi
  • V. Lombardi
  • E. Masiello
  • P. Premoli
  • E. Bianconi
  • C. Cusini
  • S. Rosetti
  • M. L. Tanda
  • A. Toniolo
  • M. Ferrario
  • L. BartalenaEmail author
Original Article

Abstract

Objective

Hypothyroidism is complicated by neuromuscular symptoms (myalgias, slowness of movements, and tiredness) and signs (easy fatigability and cramps), which may have a negative impact on general well-being and quality of life. In a pilot, prospective, controlled study, we investigated the features of muscle dysfunction in hypothyroidism by disease questionnaire, biochemical measures, and physical performance tests.

Materials and Methods

Fifty-seven consecutive patients with newly diagnosed hypothyroidism were enrolled, 27 subclinical (S-Hypo) and 30 overt (O-Hypo). A series of 30 euthyroid subjects, with similar demographic characteristics, served as controls. Patients were administered a short disease questionnaire and underwent laboratory exams and standardized physical tests, both at baseline and after restoration of biochemical euthyroidism.

Results

Compared to euthyroid controls, the O-Hypo group showed significantly higher prevalence of neuromuscular symptoms and significantly higher serum creatine phosphokinase (CPK) levels (p value < 0.0001). S-Hypo had slightly higher CPK levels and prevalence of neuromuscular symptoms than controls. Both S-Hypo and O-Hypo patients performed worse than controls in the six-minute walking test. Differences between patients and controls in handgrip strength test and timed chair standing test failed to reach statistical significance (although a trend was noticeable), possibly due to the small sample size. In O-Hypo, an inverse correlation was found between CPK levels and the handgrip strength test (p value < 0.001). Restoration of euthyroidism was associated with normalization of questionnaire responses, six-minute walking test, as well as serum CPK levels.

Conclusion

In addition to neuromuscular symptoms, hypothyroidism is associated with abnormalities of physical performance. The six-minute walking test is the most valuable test to assess this aspect. In the pilot study, levothyroxine therapy could reverse muscle functional abnormalities.

Keywords

Physical performance Hypothyroidism Physical tests Handgrip strength test Six-minute walking test Timed chair standing test 

Notes

Acknowledgements

Daniela Gallo is supported by a University of Insubria Ph.D. scholarship. The statistical analysis was performed by Giovanni Veronesi.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, Wemeau JL (2013) ETA guidelines: management of subclinical hypothyroidism. Eur Thyroid J 2 (15): 215–228CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Watt T, Cramon P, Hegedüs L, Bjorner JB, Bonnema SJ, Rasmussen ÅK, Feldt-Rasmussen U, Groenvold M (2014) The thyroid-related quality of life measure ThyPRO has good responsiveness and ability to detect relevant treatment effects. J Clin Endocrinol Metab 99(10):3708–3717CrossRefPubMedGoogle Scholar
  3. 3.
    Vigário P, Teixeira P, Reuters V, Almeida C, Maia M, Silva M, Vaisman M (2009) Perceived health status of women with overt and subclinical hypothyroidism. Med Princ and Pract 18:317–322Google Scholar
  4. 4.
    Rhee CM, Curhan GC, Alexander EK, Bhan I, Brunelli SM (2013) Subclinical hypothyroidism and survival: the effects of heart failure and race. J Clin Endocrinol Metab 98(6):2326–2336CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Samuels MH (2014) Psychiatric and cognitive manifestations of hypothyrodism. Curr Opin Endocrinol Diabetes Obes 21(5):377–383CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kahaly GJ, Dillmann WH (2005) Thyroid hormone action in the heart. Endocr Rev 26(5):704–728CrossRefPubMedGoogle Scholar
  7. 7.
    de Jongh RT, Lips P, van Schoor NM, Rijs KJ, Deeg DJ, Comijis HC, Kramer MH, Vandenbroucke JP, Dekkers OM (2011) Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals. Eur J Endocrinol 165(4):545–554CrossRefPubMedGoogle Scholar
  8. 8.
    Lankahaar JAC, de Vries WR, Jansen JACG, Zelissen PMJ, Backx FJG (2014) Impact of overt and subclinical hypothyroidism on exercise tolerance: a systematic review. Res Q Exerc Sport 85(3):365–389CrossRefGoogle Scholar
  9. 9.
    Caraccio N, Natali A, Sironi A, Baldi S, Frascerra S, Dardano A, Monzani F, Ferrannini E (2005) Muscle metabolism and exercise tolerance in subclinical hypothyroidism: a controlled trial with levothyroxine. J Clin Endocrinol Metab 90(7):4057–4062CrossRefPubMedGoogle Scholar
  10. 10.
    Shatynska-Mytsyk I, Rodrigo L, Cioccocioppo R Petrovic D, Lakusic N, Compostella L, Novak M, Kruzliak P (2016) The impact of thyroid hormone replacement therapy on left ventricular diastolic function in patients with subclinical hypothyroidism. J Endocrinol Invest 39(6):709–713CrossRefPubMedGoogle Scholar
  11. 11.
    Biondi B, Klein I (2004) Hypothyroidism as a risk factor for cardiovascular disease. Endocr 24(1):1–13CrossRefGoogle Scholar
  12. 12.
    Biondi B (2007) Cardiovascular effects of mild hypothyroidism. Thyroid 17(7):625–630CrossRefPubMedGoogle Scholar
  13. 13.
    Piantanida E, Gallo D, Veronesi G, Pariani N, Masiello E, Premoli P, Sassi L, Lai A, Tanda ML, Ferrario M, Bartalena L (2016) Masked hypertension in newly diagnosed hypothyroidism: a pilot study. J Endocrinol Invest 39:1131–1138CrossRefPubMedGoogle Scholar
  14. 14.
    Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WHJP (2000) Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psych 68:750–755CrossRefGoogle Scholar
  15. 15.
    Monzani F, Caraccio N, Siciliano G, Manca L, Murri L, Ferrannini E (1997) Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism. J Clin Endocrinol Metab 82(10):3315–3318CrossRefPubMedGoogle Scholar
  16. 16.
    Visser WE, Heemstra KA, Swagemakers SM, Ozgür Z, Corssmit EP, Burggraaf J, van Ijcken WF, van der Spek PJ, Smit JW, Visser TJ (2009) Physiological thyroid hormone levels regulate skeletal muscle transcripts. J Clin Endocrinol Metab 94(9):3487–3496CrossRefPubMedGoogle Scholar
  17. 17.
    Salvatore D (2014) Thyroid Hormones and skeletal muscle—new insights and potential implications. Nat Rev Endocrinol 10(4):206–214CrossRefPubMedGoogle Scholar
  18. 18.
    Monzani F, Caraccio N, Del Guerra P, Casolaro A, Ferrannini E. Neuromuscular symptoms and dysfunction in subclinical hypothyroid patients: beneficial effect of L-T4 replacement therapy. Clin Endocrinol (Oxf) 1999; 51 (2): 237–242CrossRefGoogle Scholar
  19. 19.
    Simonides WS, van Hardeveid C (2008) Thyroid hormone as a determinant of metabolic and contractile phenotype of skeletal muscle. Thyroid 18(2):205–216CrossRefPubMedGoogle Scholar
  20. 20.
    Lombardi A, De Matteis R, Moreno M, Napolitano L, Busiello RA, Senese R, de Lange P, Lanni A, Goglia F (2012) Responses of skeletal muscle lipid metabolism in rat gastrocnemius and iodothyronine administration: a putative role for FAT/CD36. Am J Physiol Endocrinol Metab 303:E1222–E1233CrossRefPubMedGoogle Scholar
  21. 21.
    Magri F, Buoncuore M, Oliviero A, Rotondi M, Gatti A, Accornero S, Camera A, Chiovato L (2010) Intraepidermal nerve fiber density reduction as a marker of preclinical asymptomatic small-fiber sensory neuropathy in hypothyroid patients. Eur J Endocrinol 163:279–284CrossRefPubMedGoogle Scholar
  22. 22.
    Khaleeli AA, Griffith DG, Edwards RH (1983) The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle. Clin Endocrinol (Oxf) 19:365–367CrossRefGoogle Scholar
  23. 23.
    Winther KH, Cramon P, Watt T, Bjorner JB, Ekholm O, Feldt-Rasmussen U, Groenvold M, Rasmussen ÅK, Hegedüs L, Bonnema SJ (2016) Disease-specific as well as generic quality of life is widely impacted in autoimmune hypothyroidism and improves during the first six months of levothyroxine therapy. PLoS One 11(6):0156925CrossRefGoogle Scholar
  24. 24.
    Mainenti MR, Vigário PS, Teixeira PF, Maia MD, Oliveira FP, Vaisman M (2009) Effect of levothyroxine replacement on exercise performance in subclinical hypothyroidism. J Endocrinol Invest 32(5):470–473CrossRefPubMedGoogle Scholar
  25. 25.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16(1):31–41CrossRefPubMedGoogle Scholar
  26. 26.
    Simeoni M, Cerantonio A, Pastore I, Liguori R, Greco M, Foti D, Gulletta E, Brunetti A, Fuiano G (2016) The correct renal function evaluation in patients with thyroid dysfunction. J Endocrinol Invest 39:495–507CrossRefPubMedGoogle Scholar
  27. 27.
    NHLBI Obesity Education Initiative. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. National Institutes of Health 2000; NIH Publication Number 00-4084Google Scholar
  28. 28.
    Schlussel MM, Dos Anjos LA, de Vasconcellos MT, Kac M (2008) References values of hand grip dynamometry of healthy adults: a population-based study. Clin Nutr 27:601–607CrossRefPubMedGoogle Scholar
  29. 29.
    Fess EE (1992) Grip strength. In: Casanova JS (ed) Clinical assessment recommendations, 2nd edn. American Society of Hand Therapists, Chicago, pp 41–45Google Scholar
  30. 30.
    Enright PL, McBurnie MA, Bittner V, Tracy RP, McNamara R, Arnold A, Newman AB (2003) The 6-minute walking test: a quick measure of functional status in elderly adults. Chest 123(2):387–398CrossRefPubMedGoogle Scholar
  31. 31.
    Faggiano P, D’Aloia A, Gualeni A, Brentano L, Dei Cas L (2004) The 6 min walking test in chronic heart failure: indications, interpretation and limitations from a review of the literature. Eur J Heart Fail 6:687–691CrossRefPubMedGoogle Scholar
  32. 32.
    Macfarlane DJ, Chou KL, Cheng HI, Chi I (2006) Validity and normative data for thirty-second chair stand test in elderly community - dwelling Hong Kong Chinese. Am J Hum Biol 18(3):418–421CrossRefPubMedGoogle Scholar
  33. 33.
    Wiersinga WM (2015) Guidance in subclinical hyperthyroidism and subclinical hypothyroidism: are we making progress? Eur Thyroid J 4(3):143–148CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Watt T, Hegedüs L, Groenvold M, Bjorner JB, Rasmussen ÅK, Bonnema SJ, Feldt-Rasmussen U (2010) Validity and reliability of the novel thyroid-specific quality of life questionnaire, ThyPRO. Eur J Endocrinol 162:161–167CrossRefPubMedGoogle Scholar
  35. 35.
    Giampietro O, Clerico A, Buzzigoli G, Del Chicca MG, Boni C, Carpi A (1984) Detection of hypothyroid myopathy by measurement of various serum muscle markers–myoglobin, creatine kinase, lactate dehydrogenase and their isoenzymes. Correlation with thyroid hormone levels (free and total) and clinical usefulness. Horm Res 19(4):232–242CrossRefPubMedGoogle Scholar
  36. 36.
    Khaleeli A, Gohil K, McPhail G, Round JR, Edwards R (1983) Muscle morphology and metabolism in hypothyroid myopathy: effects of treatment. J Clin Pathol 36:519–526CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    McKeran RO, Ward P, Slavin G, Paul EA (1979) Central nuclear counts in muscle fibres before and during treatment in hypothyroid myopathy. J Clin Pathol 3(32):229–233CrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2017

Authors and Affiliations

  • D. Gallo
    • 1
  • E. Piantanida
    • 1
    Email author
  • G. Veronesi
    • 1
    • 3
  • A. Lai
    • 1
  • L. Sassi
    • 1
  • V. Lombardi
    • 1
  • E. Masiello
    • 1
  • P. Premoli
    • 1
  • E. Bianconi
    • 1
  • C. Cusini
    • 1
  • S. Rosetti
    • 1
  • M. L. Tanda
    • 1
  • A. Toniolo
    • 2
  • M. Ferrario
    • 1
  • L. Bartalena
    • 1
    Email author
  1. 1.Endocrine Unit, Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
  2. 2.Department of Biotechnology and Life ScienceUniversity of InsubriaVareseItaly
  3. 3.Research Center in Epidemiology and Preventive Medicine (EPIMED)University of InsubriaVareseItaly

Personalised recommendations