臺灣博碩士論文加值系統

甲狀腺功能失調是最常見的內分泌疾病，甲狀腺功能亢進及甲狀腺功能低下都會造成肌肉病變及臨床上肌力的減退。本研究在於找出是否myostatin、follistatin及IGF-1是否參與甲狀腺功能失調所引發的肌肉病變，以及經過治療後肌肉力量的改善中myostatin pathway是否也有扮演重要的角色。
依診斷分為兩組:：1.甲狀腺功能亢進之病患，甲狀腺功能亢進之定義為Free T4大於參考值及TSH小於參考值；2.對照組，甲狀腺功能正常，沒有排除條件者
於收案抽驗血液每次抽血量為10ml，檢驗Free T4、TSH。利用酵素免疫分析法(Enzyme-link immunosorbent assay, ELISA)，來定量serum myostatin protein，及IGF-1。
實驗組中，甲狀腺功能亢進者接受口服抗甲狀腺藥物治療二十四週，甲狀腺功能亢進組以Carbimazole 每日5mg至30mg分一至三次使用，或Propylthiouracil每日50mg至300mg分一至三次使用。在試驗中持續使用，依患者狀況至少於每八週應抽血檢驗甲狀腺功能並回診，並依追蹤之血液free T4、TSH濃度調整劑量，完成試驗後應繼續治療。其間無禁止合併使用藥物。若治療24週未達成甲狀腺功能正常之個案可繼續進行抗甲狀腺口服藥物治療，或改以甲狀腺半全切除術(Subtotal thyroidectomy)治療，或放射碘治療。
對照組則在收案後完成抽血檢驗後結案。
檢驗項目：1.Myostatin及IGF-1需於接受治療前及接受治療後的第24週抽血時抽血檢驗；2. 於接受治療前及接受治療後的第24週抽血檢驗白蛋白（albumin)、天門冬胺酸轉胺酶(Aspartate aminotransferase, AST)、丙胺酸轉胺酶（Alanine amino-transferase ,ALT)與肌酸酐(Creatinine, Cre.)。
此研究包括24位甲狀腺機能亢進的患者以及31位對照組，對照組和實驗組以隨機的方式選取。甲狀腺機能亢進的患者相較甲狀腺正能的對照組血清的myostatin平均濃度沒有顯著差異但血清的IGF-1平均濃度增加。藥物治療二十四週後，血清的myostatin及IGF-1的平均濃度都沒有顯著改變。二十四個甲狀腺機能亢進的患者在藥物治療二十四週後，十一位個案血清的myostatin濃度減少而十三位個案為增加。

Objectives: Myostatin, a negative regulator of skeletal muscle growth, may modulate muscle in myopathy after development.
Background: Both hypothyroidism and hyperthyroidism may cause signs and symptoms of neuromuscular dysfunction. We hypothesized that serum myostatin level might be related to myopathy in hyperthyroidism.
Method: We measure serum myostatin level in patients with hyperthyroidism and normal control, and check serum myostatin again after anti-thyroid drugs used in patients with hyperthyroidism for 24 weeks. .
Results There is no elevation of serum myostatin level but elevated serum IGF-1 level, compared to euthyroidism. After anti-thyroid medication for 24 weeks, no significant increase of serum myostatin protein levels was found and the serum IGF-1 level also had no obvious change. 11 of 24 patients have decrease of serum myostatin protein levels after medication for 24 weeks
Conclusions： There are no changes in myostatin level before and after medication. Serum IGF-1 increase in patients with hyperthyroidism and no change after treatment. Advanced measurement of serum and muscle myostatin protein, myostatin mRNA, follistatin and other muscle related markers in more cases could be done.

致謝 ………………………..………………………………………..……………….1
目錄 ……………….………...……………………………………………………….2
表目錄 …………….…….……………………………………………………………3
圖目錄 …………….…………………….………………..……………………….…4
第一章 中文摘要…….…….………………………………….……………………..5
第二章 緒論…………..………………………………………………….…….…….7
第一節 研究背景………………………………………………………….…7
第二節 研究目的………………………………………………………….…8
第三章 研究材料與方法………..………………………………………………......9
第四章 研究結果……………….……………………………...............................11
第五章 討論……………………...………………...............................................14
第六章 侷限與展望…………….…………………………..……….....................16
第七章 英文摘要..……….……………..………………………..........................18
第八章 參考文獻……………….…………………….........................................19
第九章 圖表………………………………….....................................................22

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