PMID- 12213666
OWN - NLM
STAT- MEDLINE
DCOM- 20021029
LR  - 20190906
IS  - 0804-4643 (Print)
IS  - 0804-4643 (Linking)
VI  - 147
IP  - 3
DP  - 2002 Sep
TI  - Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves' disease and 
      their reversibility with carbimazole therapy.
PG  - 299-303
AB  - OBJECTIVES: Dyspnoea is a common complaint among patients with thyrotoxicosis. 
      However, its causative mechanisms have not been identified. We assessed the role 
      of thoracic diaphragmatic muscle weakness in dyspnoea among patients with active 
      Graves' disease. METHODS: Twenty-seven patients (19 female, 8 male) with active 
      Graves' disease were assessed for the clinical severity of dyspnoea, functional 
      (pressure generating capacity) and anatomical aspects (thickness and excursion) 
      of the diaphragm at presentation. The severity of dyspnoea was assessed using a 
      visual analogue scale (VAS) and the 6 min walk test. Lung function tests, 
      diaphragmatic strength (sniff oesophageal pressure, SniffP(oeso)), maximum 
      inspiratory and expiratory pressures, diaphragmatic thickness and movements on 
      real time ultrasonography were evaluated during normal and deep respiration. 
      Twenty of the 27 patients were reassessed after achieving euthyroidism with 
      carbimazole therapy at a mean interval of 5+/-2 months. RESULTS: Reevaluation 
      after carbimazole therapy revealed a significant reduction in dyspnoea on the VAS 
      (59+/-26 to 23+/-13%). Patients covered a similar distance during the 6 min walk 
      before and after euthyroidism. Significant improvement was observed in the vital 
      capacity (2.57+/-0.62 to 2.94+/-0.60 l), forced expiratory volume in the first 
      second (2.21+/-0.49 to 2.45+/-0.47 l), total lung capacity (3.57+/-1.19 to 
      4.1+/-1.12 l), diaphragmatic movement during deep respiration (5.5+/-1.0 to 
      6.6+/-1.1 cm) and SniffP(oeso) (68.7+/-23 to 93.1+/-25.2 cmH(2)O). There was no 
      significant change in the distance walked in 6 min, tidal volume, lung diffusion 
      capacity and diaphragmatic thickness. There was no significant correlation 
      between the net change in dyspnoea score and net change in lung function tests, 
      diaphragmatic movement and SniffP(oeso). CONCLUSIONS: Significant functional 
      weakness of diaphragm muscle is present in patients with active Graves' disease. 
      This weakness is more marked during a maximal respiratory manoeuvre, indicating a 
      diminished diaphragmatic reserve which could be the cause of dyspnoea observed on 
      exertion among patients with thyrotoxicosis.
FAU - Goswami, Ravinder
AU  - Goswami R
AD  - Department of Endocrinology, All India Institute of Medical Sciences, New Delhi 
      110029, India. gosravinder@hotmail.com
FAU - Guleria, Randeep
AU  - Guleria R
FAU - Gupta, Arun Kumar
AU  - Gupta AK
FAU - Gupta, Nandita
AU  - Gupta N
FAU - Marwaha, Raman Kumar
AU  - Marwaha RK
FAU - Pande, Jitender Nath
AU  - Pande JN
FAU - Kochupillai, Narayana
AU  - Kochupillai N
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur J Endocrinol
JT  - European journal of endocrinology
JID - 9423848
RN  - 0 (Antithyroid Agents)
RN  - 06LU7C9H1V (Triiodothyronine)
RN  - 8KQ660G60G (Carbimazole)
RN  - Q51BO43MG4 (Thyroxine)
SB  - IM
MH  - Adult
MH  - Antithyroid Agents/*therapeutic use
MH  - Carbimazole/*therapeutic use
MH  - *Diaphragm/physiopathology
MH  - Dyspnea/epidemiology/*etiology
MH  - Exercise
MH  - Female
MH  - Forced Expiratory Volume
MH  - Graves Disease/*complications/drug therapy
MH  - Humans
MH  - Lung Volume Measurements
MH  - Male
MH  - Middle Aged
MH  - Muscle Weakness/epidemiology/*etiology
MH  - Respiratory Function Tests
MH  - Thyroxine/blood
MH  - Triiodothyronine/blood
MH  - Vital Capacity
EDAT- 2002/09/06 10:00
MHDA- 2002/10/31 04:00
CRDT- 2002/09/06 10:00
PHST- 2002/09/06 10:00 [pubmed]
PHST- 2002/10/31 04:00 [medline]
PHST- 2002/09/06 10:00 [entrez]
AID - 1470299 [pii]
AID - 10.1530/eje.0.1470299 [doi]
PST - ppublish
SO  - Eur J Endocrinol. 2002 Sep;147(3):299-303. doi: 10.1530/eje.0.1470299.