Appendicular Skeletal Muscle Mass Index and Physiological Performance in Post-Menopausal Women with Total Thyroidectomy
and Szu-Chia Chen 1,7,8,9,*Round 1
Reviewer 1 Report
This study investigates the appendicular skeletal muscle mass and physiological performance in post-menopausal women with total thyroidectomy. It is accepted after minor revisions:
1) The reference is missing in the last sentence of the second paragraph (lines 52-54).
2) In line 121 "percentile" it is better to be written in full.
3) Υou doesn't indicate which method you used to detect muscle dysfunction. For example, you referred to the tests detecting poor physical performance, but you don't refer to which test was used in this study. Furthermore, you could have mentioned the cut-off points for both muscle strength and physical performance methods.
Author Response
1) The reference is missing in the last sentence of the second paragraph (lines 52-54).
Response: In this paragraph ,we are trying to express we are the first study who investigate on the effect of levothyroxine and sarcopenia. Therefore we rephrase our sentence to "there is no known study that has investigated yet".
2) In line 121 "percentile" it is better to be written in full.
Response : Already corrected.
3) Υou doesn't indicate which method you used to detect muscle dysfunction. For example, you referred to the tests detecting poor physical performance, but you don't refer to which test was used in this study. Furthermore, you could have mentioned the cut-off points for both muscle strength and physical performance methods.
Response: In line 137-139 , we now indicate the method we used for muscle function.
Reviewer 2 Report
In the revised manuscript, I found that points suggested in the first review are sufficiently addressed and improved. Thank you for author's effort.
One small point, that some typos are still out there, for example, ( IGF-1) --> (IGF-1) at line 67. Might be corrected in proofreading afterwards.
Author Response
One small point, that some typos are still out there, for example, ( IGF-1) --> (IGF-1) at line 67. Might be corrected in proofreading afterwards.
Response: It's corrected now.
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
Round 1
Reviewer 1 Report
The content of the review is satisfying. English is at a good level.
In the introduction there could be a reference to the criteria used in clinical practice to identify sarcopenia. Are there any biomarkers that are applicable in the detection of sarcopenia?
The content of the conclusions could have more information.It could mention concerns and suggestions for new research that could be done in the future.
Reviewer 2 Report
I read the manuscript "Early Sarcopenia in Post-Menopausal Women under Long Term Levothyroxine Supply with Decreased Skeletal Muscle Mass and Physiological Performance " by Wen et al with interest, since muscle catabolism might be a potential consequence of long-standing thyroid dysfunction. While the study delves into an interesting topic, I noted that there are lots of rooms for improvement in this study, and also found some points should be addressed.
Point 1. Current study design cannot assess the research question 'early sarcopenia' in 'long term levothyroxine supply'. The analysis does not include such variables like area under curve (duration * strength/dosage) in study population. The study does not include any control group (for example, without t4 supply).
Point 2. There are a lot of potentially limiting issues for this single center, small sized, cross-sectional study in Chinese patients, including generalizability. But discussion section of the manuscript lacks any address on study limitations.
Point 3. While long-standing overdosage with T4, resultantly long-standing suppressed TSH may result in decreased muscle mass, we cannot draw that point by merely observing muscle mass at some point and TSH level at the same time point. TSH level can be very dynamic and volatile, and to assess this hypothesis, long-term area under curve of TSH should be recorded with repeated measures. Therefore, at least from the results shown in the manuscript, we cannot draw a conclusion suggesting potentially adverse effects of TSH suppression on muscle health.
Reviewer 3 Report
The present manuscript is a cross-sectional study that aims to analyze sarcopenia and its related determinants in 50 postmenopausal women who had undergone total thyroidectomy.
Methods,Could the authors calculate the sample size to see if it is representative?
Could the authors change the concept elderly to older?
Could the authors add which variables they included in the regression models? All of them?
Results,
There are only 4 participants with 1 criterion of sarcopenia and it has not been analysed if these 4 have the second criterion that should be fulfilled to have sarcopenia. I think that the sample of 4 is not representative and therefore it is not possible to talk about sarcopenia, we could talk about low skeletal muscle index.
The authors should therefore modify the concept of sarcopenia throughout the manuscript, and the discussion is focused on the results obtained with the 4 participants who do not have sarcopenia. Early sarcopenia is a concept that is not covered in the latest revision of the criteria. This concept should be revised.
Could the authors add the R2 and F and the significance of each of the models constructed?
