A Case of Elevation of Serum Creatine Kinase With Antithyroid Medications for Graves’ Disease
Bibliographic record
Abstract
We describe a female patient with Graves ’ disease (GD) who had abnormal increases of serum creatine kinase (CK) concentration during treatment with antithyroid medications. She experienced myalgia and manifested increased serum CK levels, with a maximum of 7,925 U / L, 2 - 4 months after initiation of methimazole (MMI) treatment at a dose of 10 - 15 mg / day. After MMI was exchanged for potassium iodide (KI), serum CK levels decreased and the myalgia resolved. However, after KI was exchanged for propylthiouracil (PTU), the myalgia recurred and serum CK levels increased with a maximum of 521 U / L. PTU was discontinued and serum CK levels returned to normal, but hyperthyroidism recurred and the patient did not consent to the alteration of treatment from antithyroid drugs to radioiodine therapy or surgical treatment. PTU was restarted and increased gradually from 50 to 300 mg / day. Serum CK levels did not increase, but the hyperthyroidism persisted. After we exchanged PTU for MMI (20 mg / day) and levothyroxine (25 u g / day), serum CK levels did not increase and the hyperthyroidism diminished. While the mechanisms for this process are not clearly defined, a rapid reduction in thyroid hormones in tissues following chronic hyperthyroidism may result in relative hypothyroid states and subsequent alterations in CK concentration. doi: http://dx.doi.org/10.4021/jem130w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".