Carpal Tunnel Syndrome in Hypothyroid Patients: The Effect of Hormone Replacement Therapy
American Journal of Internal Medicine
Volume 2, Issue 3, May 2014, Pages: 54-58
Received: May 9, 2014; Accepted: May 26, 2014; Published: Jun. 20, 2014
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Arafat A. Kasem, Department of Internal medicine, Faculty of Medicine, Al Azhar University, Cairo, Egypt
Sabry M. Fathy, Department of Neurology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
Doaa A. Shahin, Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Amir A. Fikry, Department of Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Objectives: To assess the electrodiagnostic evidence of median nerve dysfunction in newly diagnosed hypothyroid patients before and after hormone replacement therapy. Patients and methods: Fifty seven patients (fifty females and seven males) their age ranging from 23 to 61 years diagnosed with hypothyroidism,proved by thyroid hormone profile,were included in this study. Electrodiagnostic workup performed at the initial time of diagnosis and after 3 months including motor and sensory median nerve conduction studies in both right and left median nerves. Results: In our studied group, TSH levels were 30.77±23.51 IU/ mL before hormone replacement therapy and 5.25±1.72 IU/mL after the treatment. FT4 values were 9.2±1.54 pmol/l before treatment and 15.42±2.62pmol/l after treatment. FT3 levels were measured as 1.69±0.63Pmol/l at the diagnosis and 4.23±1.04 Pmol/l after treatment. The pre and post therapy levels difference of all previous parameters were statistically significant(P =0.001). Forty eight patients were normalized after treatment, while nine (13.8%) still had carpal tunnel syndrome symptoms. The differences between before treatment values of median nerve sensory and motor functions in both right and left median nerves respectively (sensory distal latency, sensory nerve conduction velocity, the sensory amplitude, the motor distal latency, the motor conduction velocity and the motor amplitude)(4.156±0.49 and 14.789±8.36 , 51.730±2.32 and 52.088±2.42, 28.123±8.52 and 25.193±5.74 , 4.404±0.66 and 4.393±0.61, 53.074±3.38 and 52.867±3.82 , 4.830±1.09 and 4.984±1.29 ) and after treatment values (3.365±0.44 and 3.561±0.46 , 63.649±2.16 and 63.035±3.56 , 33.123±7.16 and 29.280±5.39 , 3.674±0.52 and 3.767±0.46 , 64.193±2.79 and 63.789±4.00 , 5.368±1.18 and 5.488±1.19 ) were all significant (P =0.001). Conclusion: With hormonal replacement therapy, carpal tunnel syndrome can be reserved in patients with hypothyroidism within three months.
Carpal Tunnel Syndrome, Hypothyroidism, Median Nerve
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Arafat A. Kasem, Sabry M. Fathy, Doaa A. Shahin, Amir A. Fikry, Carpal Tunnel Syndrome in Hypothyroid Patients: The Effect of Hormone Replacement Therapy, American Journal of Internal Medicine. Vol. 2, No. 3, 2014, pp. 54-58. doi: 10.11648/j.ajim.20140203.14
Allessio P, Alessandro S, Elena A, Giovanni M, Michele C, Carlo D, Andrea M. Morphologic and functional evaluation of the carpal tunnel syndrome before and after treatment. 116(1) ( sup-plement) 2011.
Arikan E, Pekindil G, Guldiken S, Pekindil Y. Evaluation of median nerve in subclinical hypothyroidism by high-resolution sonography. Turkish Journal of Endocrinology and Metabolism, 2005, (1) : 63-67.
Beghni E, Deledovici M, Boglium G, Crespi V, Paleari F, Gamba P, Capra M, Zarrelli. Hypothyroidism and polyneuropathy. J Neurol Neurosurg. Psychiatry; 52: 1420-1423, 1989.
Dawson DM. Entrapment neuropathies of the upper extrimities. N Engl J Med. 1993; 329 :( 2013).
Deniz Y, Eda E, Filiz K. The effects of hypothyroidism on strength-duration properties of peripheral nerve. J. Neurological Sciences 294(1-2): 89-91. 2010.
Dijk MAJ, Reitsma JB, Fischer JC, Sanders GTB. Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome. A systematic review. Clinical Chemistry 2003, 49(9): 1437-1444.
Duffy RF, Van den Bosch J, Laman DM, van Loon BJB, Linssen WHJP. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J. Neurol. Neurosurg. Psychiatry 2000, 68: 750-755.
El-salem K, Ammari F. Neurophysiological changes in neurologically A symptomatic Hypothyroid patients: A prospective cohort study.Journal Clinical Neurophysiology. 23(6): 568-572.
Eslamin F, Bahrami A, Niafar M, Salehzamani Y, Behkamrad K. Electrophysiologic changes in patients with untreated primary hypothyroidism. J. Clinical Neurophysiol 28(3): 323-328. 2011.
Ferracci F, Carnevale A. The neurological disorder associated with thyroid autoimmunity. J. Neurol. 2006; 253(8): 975-984.
Ferreira AA, Nazario JC, Periera PJ, Azevedo NL, Barradas PC. Effects of experimental hypothyroidism on myelin sheath structural organization. J. Neurocytol.2004; 33(2): 225-231.
Galea LA, Gatt R, Sciberras C: Hand and wrist configurations in patients with carpal tunnel syndrome. Malta Medical Journal 2007; 19(02): 32-34.
Ganong WF. The thyroid gland. In: Review of medical physiology 21 Edition. MC Graw Hill, Boston 2003, pp 320-335.
Giuseppel And Grazia D. Skin biopsy as a diagnostic tool in peripheral neuropathy. Nature Clinical Practice Neurology.2oo7; 3(10): 546-557.
Jameson JL, Wretman AP. Disorders of thyroid gland. In: Braunwald E, Fauci AS, Kasper DL, Editors. Harrison's Principles of Internal Medicine, 15th ed. Mc Graw-Hill; 2001: 2060-84.
Kececi H, Degirmenci Y. Hor-mone replacement therapy in hypothyroidism and nerve conduction study. Clinical Neurophysi-ology; 2006; 36: 79-83.
Khedr EM, El-toony LF, Tarkhan MN, Abdalla G. Peripheral and central nervous system alterations in hypothyroidism: Electrophysiological findings. Neuropsy-chobiology., 41(2): 88-94; 2000.
Kimura G. Assesment of individual nerves. Electrodiag-nosis in diseases of nerve and muscle: Principles and practice Edition 3. New York: Oxford Univer-sity Press; 2001: 130-77.
Nebuchennykh M, Loseth S, Mellegren S. Aspects of peripheral nerve involvement in patients with treated hypothyroidism. European Journal of Neurology, issue1, pages 67-72, 2010.
Nemni R, Bottachi E, Fazio R. Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological finding in our cases.J Neurol Neurosurg Psychiatry 1987; 50: 1454-60.
Preston DC, Shapiro BE. Electromyography and neuromuscular dis-orders, 2nd edition. Appendix; Butterworth- Heinemann; 2005: 561-4.
Rao SN, Katiyar BC, Nair KR, Misra S. Neuromuscular status in hypothyroidism. Acta Neurol Scand 1980; 61 : 167-77.
Sabina Y, Noorzadah B, Shelina B. Motor neuropathy in hypothyroidism: clinical and electrophysiological findings. BSMMU J. 2008; 1(1): 15-18.
Shirabe T, Tawara S, Terao A, Araki S. Myxedematous poly neuropathy. A light and electron microscopy study of the peri-pheral nerve and muscle. J. Neurol. Neurosurg. Psychiatry 1975; 38: 241-7.
Somay G, Of-lazoglo B, Us O, Surandamar A. Neuromuscular status of thyroid diseases, a prospective clinical and electrodiagnostic study. Electromyogr. Clin. Neurophysiol. 2007; 47(2): 67-78.
Yeasmin S,Begum S, Rahman SMH. Sensory neuropathy in hypothyroidism: Elec-trophysiological and clinical findings. Journal Of Bangladish Society Of Physiologist, Volume 2, 2007: 1-6.
Yuksel G, Karlikaya G, Tanridag T, Us O, Akyuz G. Nerve conduction studies, SEP and Blink reflex studies in recently diagnosed, untreated thyroid disease patients. J. Neurol. Sci.[ Turk] 2007; 24:7-15.
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