Araştırma Makalesi
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Hashimoto Tiroiditinde Nöromusküler Fonksiyonların Değerlendirilmesi

Yıl 2022, , 761 - 772, 28.11.2022
https://doi.org/10.20515/otd.1142946

Öz

Hashimoto tiroiditi, görülme sıklığı artan en sık görülen otoimmün tiroid hastalığıdır. Hashimoto tiroiditinin kesin nedenleri ve patogenezi henüz tam olarak anlaşılamamasına rağmen, literatür immünolojik, genetik, çevresel ve epigenetik faktörlerin karmaşık etkileşimlerini göstermektedir. Genellikle nöropati ve miyopati gibi nöromüsküler sorunlara neden olabilen hipotiroidizme yol açar. Hashimoto tiroiditi hastalarının nöromüsküler fonksiyonlarına ilişkin veriler nispeten az rapor edilmiştir ve güncel değildir. Bu gözlemsel çalışma Hashimoto tiroiditi olan hastalarda nöromüsküler fonksiyonları ve sempatik deri yanıtlarını (SSR) değerlendirmeyi ve sağlıklı katılımcılarla karşılaştırmayı amaçlamıştır. Çalışmaya 33 ötiroid, 10'u subklinik hipotiroidizmli, 7'si hipotiroidizmli olmak üzere toplam 50 hasta (25 kadın, 25 erkek; yaş ortalaması 31.6±4.9 yıl; dağılım: 25-40 yıl) dahil edildi. Kontrol grubu 50 sağlıklı bireyden (25 kadın, 25 erkek; yaş ortalaması: 31.5±5.1 yıl; dağılım: 25-40 yıl) oluşuyordu. Tüm katılımcılarda sinir iletim çalışmaları, tekrarlayan sinir stimülasyonu, SSRs ve F dalga kayıtları yapıldı. Karşılaştırma gruplarında hem üst ekstremitelerde (sırasıyla p<0.001 ve p=0.013) hem de alt ekstremitelerde (sırasıyla p=0.008 ve p=0.002) ortalama SSR gecikmesi ve genliğinde anlamlı farklılıklar vardı. Karşılaştırma gruplarında iğne elektronöromiyografi (EMG) testleri açısından anlamlı fark vardı (p=0.012) ve hastaların %14'ünde miyojenik EMG bulguları saptandı. Ayrıca Hashimoto tiroiditli hastalarda EMG bulguları ile anti-TPO düzeyleri arasında anlamlı korelasyon saptandı (r=0.453; p=0.001). Hastalar ve kontrol grupları arasında sinir iletim çalışmalarında, rutin EMG testlerinde, tekrarlayan sinir stimülasyonlarında veya F dalgası kayıtlarında anlamlı fark saptanmadı. Hashimoto tiroiditi, nöromüsküler sistemlerin düzgün çalışması üzerinde olumsuz etkilere neden olabilir. SSR ve elektrofizyolojik testler, bu hastalarda nöromüsküler anormalliklerin erken tespiti ve araştırılması için faydalı olabilir.

Kaynakça

  • 1. Ralli M, Angeletti D, Fiore M, et al. Hashimoto's thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmun Rev. 2020;19:102649. doi:10.1016/j.autrev.2020.102649
  • 2. Zaletel K, Gaberšček S. Hashimoto's thyroiditis: From genes to the disease. Curr Genomics. 2011;12:576-588. doi:10.2174/138920211798120763
  • 3. Rydzewska M, Jaromin M, Pasierowska IE, et al. Role of the T and B lymphocytes in pathogenesis of autoimmune thyroid diseases. Thyroid Res. 2018;11:2. doi:10.1186/s13044-018-0046-9
  • 4. Kust D, Matesa N. The impact of familial predisposition on the development of Hashimoto's thyroiditis. Acta Clin Belg. 2020;75:104-108. doi:10.1080/17843286.2018.1555115
  • 5. Ahmed R, Al-Shaikh S, Akhtar M. Hashimoto thyroiditis: a century later. Adv Anat Pathol. 2012;19:181-186. doi:10.1097/PAP.0b013e3182534868
  • 6. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry. 2000;68:750-755. doi:10.1136/jnnp.68.6.750
  • 7. Ümit Yemişci O, Özen S, Öztürk Şişman T, Anıl C, Saraçgil Coşar SN. Sympathetic skin responses and electromyographic reaction times in chronic autoimmune thyroiditis: An overlooked electrodiagnostic study. Turk J Phys Med Rehab. 2022;68:100-106. doi:10.5606/tftrd.2022.7021.
  • 8. Eslamian F, Bahrami A, Aghamohammadzadeh N, Niafar M, Salekzamani Y, Behkamrad K. Electrophysiologic changes in patients with untreated primary hypothyroidism. J Clin Neurophysiol. 2011;28:323-328. doi:10.1097/WNP.0b013e31821c30d9
  • 9. Ozata M, Ozkardes A, Corakci A, Gundogan MA. Subclinical hypothyroidism does not lead to alterations either in peripheral nerves or in brainstem auditory evoked potentials (BAEPs). Thyroid. 1995;5:201-205. doi:10.1089/thy.1995.5.201
  • 10. Merello M, Nogues M, Leiguarda R, López Saubidet C, Florin A. Abnormal sympathetic skin response in patients with autoimmune vitiligo and primary autoimmune hypothyroidism. J Neurol. 1993;240:72-74. doi:10.1007/BF00858719
  • 11. Gautam S, Tandon OP, Awashi R, Sekhri T, Sircar SS. Correlation of autonomic indices with thyroid status. Indian J Physiol Pharmacol. 2003;47:164-170.
  • 12. Kucera P, Goldenberg Z, Kurca E. Sympathetic skin response: review of the method and its clinical use. Bratisl Lek Listy. 2004;105:108-116.
  • 13. Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response: basic mechanisms and clinical applications. Clin Auton Res. 2003;13:256-270. doi:10.1007/s10286-003-0107-5
  • 14. Bir LS, Aktan S. Sympathetic skin response in psoriasis and vitiligo. J Auton Nerv Syst. 1999;77:68-71 [published correction J Auton Nerv Syst 2000;80:114]. doi:10.1016/s0165-1838(99)00030-2
  • 15. Misiunas A, Niepomniszcze H, Ravera B, Faraj G, Faure E. Peripheral neuropathy in subclinical hypothyroidism. Thyroid. 1995;5:283-286. doi:10.1089/thy.1995.5.283
  • 16. Cruz MW, Tendrich M, Vaisman M, Novis SA. Electroneuromyography and neuromuscular findings in 16 primary hypothyroidism patients. Arq Neuropsiquiatr. 1996;54:12-18. doi:10.1590/s0004-282x1996000100002
  • 17. Nemni R, Bottacchi E, Fazio R, et al. Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases. J Neurol Neurosurg Psychiatry. 1987;50:1454-1460. doi:10.1136/jnnp.50.11.1454
  • 18. Khedr EM, El Toony LF, Tarkhan MN, Abdella G. Peripheral and central nervous system alterations in hypothyroidism: electrophysiological findings. Neuropsychobiology. 2000;41:88-94. doi:10.1159/000026638.

Evaluation of Neuromuscular Functions in Hashimoto’s Thyroiditis

Yıl 2022, , 761 - 772, 28.11.2022
https://doi.org/10.20515/otd.1142946

Öz

Hashimoto’s thyroiditis is the most prevalent autoimmune thyroid disease with an increasing incidence. Although the exact causes and pathogenesis of Hashimoto’s thyroiditis are not yet fully understood, the literature indicates complex interactions of immunologic, genetic, environmental, and epigenetic factors. It generally leads to hypothyroidism which can cause neuromuscular problems including neuropathy and myopathy. Data on neuromuscular functions of Hashimoto’s thyroiditis patients are relatively underreported and not up to date.The current observational study aimed to evaluate neuromuscular functions and sympathetic skin responses (SSR) in patients with Hashimoto’s thyroiditis and compare them with healthy participants. In total, 50 patients (25 females, 25 males; mean age, 31.6±4.9 years; range: 25-40 years) including 33 euthyroid, 10 with subclinical hypothyroidism, and 7 with hypothyroidism were included. The control group consisted of 50 healthy individuals (25 females, 25 males; mean age: 31.5±5.1 years; range, 25-40 years). Nerve conduction studies, repetitive nerve stimulation, SSRs and F wave recordings were performed in all participants. There were significant differences in the mean SSR latency and amplitude both in the upper extremities (p<0.001 and p=0.013, respectively) and in the lower extremities (p=0.008 and p=0.002, respectively) in the comparison groups. There was a significant difference in comparison groups regarding needle electroneuromyography (EMG) tests (p=0.012) and 14% of the patients showed myogenic EMG findings. In addition, a significant correlation was found between EMG findings and anti-TPO levels in the Hashimoto’s thyroiditis patients (r=0.453; p=0.001). No significant differences were found in the nerve conduction studies, routine EMG tests, repetitive nerve stimulations or F wave recordings between patients and control groups. Hashimoto’s thyroiditis, can cause negative influences on the proper functioning of neuromuscular systems. SSR, and electrophysiological tests may be beneficial for early detection and investigation of neuromuscular abnormalities in these patients.

Kaynakça

  • 1. Ralli M, Angeletti D, Fiore M, et al. Hashimoto's thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmun Rev. 2020;19:102649. doi:10.1016/j.autrev.2020.102649
  • 2. Zaletel K, Gaberšček S. Hashimoto's thyroiditis: From genes to the disease. Curr Genomics. 2011;12:576-588. doi:10.2174/138920211798120763
  • 3. Rydzewska M, Jaromin M, Pasierowska IE, et al. Role of the T and B lymphocytes in pathogenesis of autoimmune thyroid diseases. Thyroid Res. 2018;11:2. doi:10.1186/s13044-018-0046-9
  • 4. Kust D, Matesa N. The impact of familial predisposition on the development of Hashimoto's thyroiditis. Acta Clin Belg. 2020;75:104-108. doi:10.1080/17843286.2018.1555115
  • 5. Ahmed R, Al-Shaikh S, Akhtar M. Hashimoto thyroiditis: a century later. Adv Anat Pathol. 2012;19:181-186. doi:10.1097/PAP.0b013e3182534868
  • 6. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry. 2000;68:750-755. doi:10.1136/jnnp.68.6.750
  • 7. Ümit Yemişci O, Özen S, Öztürk Şişman T, Anıl C, Saraçgil Coşar SN. Sympathetic skin responses and electromyographic reaction times in chronic autoimmune thyroiditis: An overlooked electrodiagnostic study. Turk J Phys Med Rehab. 2022;68:100-106. doi:10.5606/tftrd.2022.7021.
  • 8. Eslamian F, Bahrami A, Aghamohammadzadeh N, Niafar M, Salekzamani Y, Behkamrad K. Electrophysiologic changes in patients with untreated primary hypothyroidism. J Clin Neurophysiol. 2011;28:323-328. doi:10.1097/WNP.0b013e31821c30d9
  • 9. Ozata M, Ozkardes A, Corakci A, Gundogan MA. Subclinical hypothyroidism does not lead to alterations either in peripheral nerves or in brainstem auditory evoked potentials (BAEPs). Thyroid. 1995;5:201-205. doi:10.1089/thy.1995.5.201
  • 10. Merello M, Nogues M, Leiguarda R, López Saubidet C, Florin A. Abnormal sympathetic skin response in patients with autoimmune vitiligo and primary autoimmune hypothyroidism. J Neurol. 1993;240:72-74. doi:10.1007/BF00858719
  • 11. Gautam S, Tandon OP, Awashi R, Sekhri T, Sircar SS. Correlation of autonomic indices with thyroid status. Indian J Physiol Pharmacol. 2003;47:164-170.
  • 12. Kucera P, Goldenberg Z, Kurca E. Sympathetic skin response: review of the method and its clinical use. Bratisl Lek Listy. 2004;105:108-116.
  • 13. Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response: basic mechanisms and clinical applications. Clin Auton Res. 2003;13:256-270. doi:10.1007/s10286-003-0107-5
  • 14. Bir LS, Aktan S. Sympathetic skin response in psoriasis and vitiligo. J Auton Nerv Syst. 1999;77:68-71 [published correction J Auton Nerv Syst 2000;80:114]. doi:10.1016/s0165-1838(99)00030-2
  • 15. Misiunas A, Niepomniszcze H, Ravera B, Faraj G, Faure E. Peripheral neuropathy in subclinical hypothyroidism. Thyroid. 1995;5:283-286. doi:10.1089/thy.1995.5.283
  • 16. Cruz MW, Tendrich M, Vaisman M, Novis SA. Electroneuromyography and neuromuscular findings in 16 primary hypothyroidism patients. Arq Neuropsiquiatr. 1996;54:12-18. doi:10.1590/s0004-282x1996000100002
  • 17. Nemni R, Bottacchi E, Fazio R, et al. Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases. J Neurol Neurosurg Psychiatry. 1987;50:1454-1460. doi:10.1136/jnnp.50.11.1454
  • 18. Khedr EM, El Toony LF, Tarkhan MN, Abdella G. Peripheral and central nervous system alterations in hypothyroidism: electrophysiological findings. Neuropsychobiology. 2000;41:88-94. doi:10.1159/000026638.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Halil Güllüoğlu 0000-0002-8499-5118

Hasan Armağan Uysal 0000-0002-4867-304X

Yayımlanma Tarihi 28 Kasım 2022
Yayımlandığı Sayı Yıl 2022

Kaynak Göster

Vancouver Güllüoğlu H, Uysal HA. Evaluation of Neuromuscular Functions in Hashimoto’s Thyroiditis. Osmangazi Tıp Dergisi. 2022;44(6):761-72.


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