Since thyroid hormone accelerates energy-requiring processes, a negative caloride balance often exists in the hyperthyroid state. To assess the role of this induced calorie deficit in the production of thyrotoxic myopathy, we have examined the effect of calorie deprivation on creatine excretion in experimental hyperthyroidism. Since food restriction decreases fecal excretion of thyroid hormone, a low-residue glucose-supplemented diet has been used to produce calorie-replete hyperthyroid animals having circulating thyroid hormone levels comparable to half-starved hyperthyroid animals. Calorie-deprived hyperthyroid animals have a 2–4-fold increase in creatine excretion when compared to fully fed hyperthyroid animals having comparable thyroid hormone levels. Although a negative calorie balance greatly enhances creatinuria in experimental hyperthyroidism, it is not a necessary condition for thyroid hormone-induced creatinuria. Calorie-replete hyperthyroid animals consistently gained weight, indicating a positive calorie balance. Nevertheless, these animals manifested increased creatinuria when compared to euthyroid controls. Therefore, excess thyroid hormone appears to cause muscle damage as reflected in creatinuria by a mechanism other than mobilization of muscle protein to provide endogenous calories. A study of the effect of triiodothyronine (T3) on creatine and urea excretion in fasting rats led to the same conclusion. T3 plus fasting produced a much more marked creatinuria than fasting alone. During the first 48 hr of fasting, the rate of weight loss and urea excretion were comparable in T3-treated and control animals. Nevertheless, the rate of creatine excretion during this interval was 10–12-fold increased in the T3-treated group. In these experiments, there was clearly a dissociation between T3 stimulation of urea excretion and the magnitude of creatinuria induced. Although a negative calorie balance appears to hasten the development of thyrotoxic myopathy, accelerated muscle proteolysis to supply an induced calorie deficit is not an adequate model to account for muscle involvement in hyperthyroidism.
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