Titin and Dystrophin Serum Concentration Changes in Patients Affected by Thyroid Disorders

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Original paper Endokrynologia Polska DOI: 10.5603/EP.a2020.0083 Volume/Tom 72; Number/Numer 1/2021 ISSN 0423–104X, e-ISSN 2299–8306 Titin and dystrophin serum concentration changes in patients affected by thyroid disorders Ariadna Zybek-Kocik1, Nadia Sawicka-Gutaj1, Remigiusz Domin1, Ewelina Szczepanek-Parulska1, Tomasz Krauze2, Przemysław Guzik2, Marek Ruchała1 1Department of Endocrinology, Metabolism, and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland 2Department of Cardiology-Intensive Therapy and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland Abstract Introduction: It is well established that thyroid hormones significantly affect skeletal muscle function, causing symptoms like myalgia and muscle weakness. Hypothyroid patients present increased levels of creatine kinase (CK), indicating muscle destruction. Lately, we proposed new serum markers of muscle disturbances in thyroid disorders: titin (TTN) and dystrophin (DMD). The aim of this study is to ORIGINAL PAPER determine the association between thyroid status, muscle metabolism, and serum levels of TTN and DMD in patients affected by hypo- and hyperthyroidism, before and after the treatment. Material and methods: In the study 56 subjects were enrolled. The studied group consisted of 16 patients with newly diagnosed overt hypothyroidism and 20 patients with hyperthyroidism. Twenty healthy controls were also included in the study. Body composition, thyroid hormones, and biochemical markers of muscle deterioration levels were evaluated before and after restoration of euthyroidism. Results: Dystrophin and TTN levels were noticeably lower in the hypothyroid group and hyperthyroid group in comparison with controls, at the border of statistical significance. Along with the thyroid hormones and CK normalisation, DMD levels increased in the hypothyroid group, with no significant lowering of TTN levels. However, TTN concentrations and the fT3/fT4 ratio became significantly lower than in controls. Hyperthyroid patients experienced no significant changes in TTN and DMD. Conclusions: The presented data indicate that TTN and DMD are potential new markers of musculoskeletal deterioration in thyroid disorders. In addition, the shift in TTN and DMD serum concentrations after the treatment of hypothyroidism accompanied by decreased fT3/fT4 ratio suggest the influence of the chosen therapeutic approach on muscle metabolism.(Endokrynol Pol 2021; 72 (1): 1–7) Key words: hypothyroidism; hyperthyroidism; muscle tissue; titin; dystrophin Introduction in their homeostasis [6, 7], the direct cause of the symptoms mentioned above cannot be clearly iden- Patients affected by thyroid disorders, including those tified yet. In the case of overt hypothyroidism, the suffering from hypothyroidism and those with hy- negative influence of thyroid disorder on muscle perthyroidism, often report accompanying muscular tissue can be visualised by the elevation of creatine symptoms such as weakness, fatigability, muscle pain, kinase (CK) activity, as well as lactate dehydrogenase stiffness, or cramps. However, the prevalence of these (LDH) in serum [8]. The CK serum activity, because signs and symptoms is variable [1–4]. it is a component of the muscle fibre cytosol, is gen- The majority of these symptoms, except in muscle erally positively correlated with progressing muscle strength, can be evaluated only subjectively by the pa- damage [9] Although similar changes do not appear tient. Kocabas et al. [5] showed that the muscle strength in hyperthyroid patients, these subjects usually expe- of patients with hypo- or hyperthyroidism is signifi- rience a statistically significant decrease in CK levels cantly reduced in comparison to the control group. In- due to increased renal filtration, visualised by elevated terestingly, after restoring euthyroidism, the strength estimated glomerular filtration rate (eGFR) [10]. Other parameters improved only in the hyperthyroid group; useful markers of muscle dysfunction in the case of this may be related to the fact that hypothyroidism usu- thyroid function disturbances have not been widely ally lasts much longer than hyperthyroidism until the described to date. moment of treatment, which may lead to irreversible In the recent study conducted by our team in 2018 changes at the cellular level of the muscles. [11], the new markers of disturbances in muscle tissue Due to the high complexity of the muscle cells’ metabolism due to changes in the thyrometabolic states physiology and the importance of thyroid hormones were proposed. Decreased titin (TTN) and dystrophin Remigiusz Domin, MD, Department of Endocrinology, Metabolism, and Internal Medicine, Poznan University of Medical Sciences, Przybyszewski Street 49, 60–355 Poznan, Poland, tel: (+48) 666 096 972, fax: (+48) 61 869 16 82; e-mail: [email protected] This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles 1 and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially Titin and dystrophin in thyroid disorders Ariadna Zybek-Kocik et al. (DMD) serum concentrations were shown on a large The measurements of TSH, fT3, fT4, CK, and glucose concentrations group of patients affected by overt hypo- or hyperthy- were done with the use of a Hitachi Cobas e601 chemiluminescent analyser (Roche Diagnostics). Thyroid autoantibody concentrations roidism, compared with healthy controls. The authors were assessed by a radioimmunological method with the use of hypothesised that changes in serum concentrations commercially available BRAMHS anti-TPO, anti-Tg, and TRAK RIA of these large, structural muscle tissue proteins might kits, and a scintillation gamma counter (LKB Wallac Clini Gamma 1272). Irisin serum concentration was measured using ELISA As- reflect the alterations in muscle tissue metabolism. It say Kit from Phoenix Pharmaceuticals — Catalogue No. EK-067-29 was concluded, because the dynamics of those changes — Irisin, Recombinant (Human, Rat, Mouse, Canine) ELISA Kit. were in contrast to the case of CK, that the dysfunction DMD and TTN concentrations were evaluated with ELISA Assay Kit by Shanghai Sunred Biological Technology. Both kits (Catalogue of muscle fibres might be the result of decreased pro- No. 201-12-5116 for TTN and 201-12-1446 for DMD) are based on duction of these proteins, not leakage from destructed the principle of double-antibody sandwich technique, with the cells. It is worth noting that it was the first description use of monoclonal antibodies. These assays have high sensitivity and specificity for the detection of TTN and DMD, and no signifi- of the dynamics of changes of TTN and DMD and their cant cross-reactivity of interference between TTN/DMD and their potential usefulness in the assessment of thyroid disor- analogues was observed. The AIXPLORER system by Supersonic ders. However, the serum concentrations of TTN and Imagine was used for ultrasonographic examination of the thy- roid gland, and the Tanita MC 180 MA analyser was used for the DMD have not yet been evaluated after the restoration evaluation of body composition. The used normal ranges included: of euthyroidism. TSH — 0.27–4.2 μIU/ml, fT3 — 3.90–6.70 pmol/L, fT4 — 11.5–21.0 ORIGINAL PAPER The aim of this study is to determine the associa- pmol/L, CK — 26.0–140.0 U/L, glucose — 70.0–99.0 mg/dL, TRAb tion between thyroid status and serum levels of TTN < 2.0 IU/L, TPOAb < 34 IU/mL, TgAb 10–115 IU/mL. and DMD in patients affected by overt hypo- and hyperthyroidism, before and after the restoration The diagnosis When the TSH concentration exceeded the reference range and of euthyroidism, which could provide more data free thyroid hormones were below the normal values, the diagnosis on the impact of thyroid disease on muscle tissue of overt hypothyroidism was established. Enrolled patients were metabolism. diagnosed with overt hyperthyroidism on the other hand, when a decrease in TSH concentration below the normal value occurred, along with an increase in free thyroid hormones concentrations Material and methods above the reference range. To establish the diagnosis of autoimmune thyroid disease, the detection of at least one elevated anti-thyroid autoantibody titre and presence of sonographic signs of chronic Enrolled subjects thyroid inflammation were required. Overt hyperthyroidism ac- The study was conducted among the population of the Wielko- companied by the elevation of TRAb titres and typical thyroid ultra- polskie Voivodeship in Poland. All participants are Caucasians sound features was mandatory for the diagnosis of Graves’ disease. of Polish origin. A total of 56 subjects were enrolled in the study. The studied group consisted of 16 patients with newly diagnosed severe overt hypothyroidism due to autoimmune thyroid disease Statistical analysis and 20 treatment-naive patients with severe overt hyperthyroidism STATISTICA software by StatSoft was applied to analyse the ac- affected by Graves’ disease. Additionally, 20 healthy control subjects quired data. Normality was checked by the Shapiro-Wilk test, and were included in the study. The exclusion criteria were similar to the equality of variances was analysed with the use of Levene’s test. those applied in the previous researches [11]. The Bioethical Com- Taking into consideration the small size of the analysed groups,
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