甲状腺功能亢进并发周围神经病(附一例报告并文献复习)

Hyperthyroidism Complicated with Polyperipheral Neropathy (A Case Report and a Literature Review)

目的 探讨甲状腺功能亢进并发周围神经病的临床表现、发病机制、电生理 (EMG)和病理特点、治疗以及预后。方法 详细收集病史及体格检查资料并进行随访观察 ,动态观察甲状腺功能 ,对比肌电图检查结果 ,并电镜观察腓肠神经活检标本。结果 此例甲状腺功能亢进并发周围神经病表现为运动重于感觉、远端重于近端 ;肌电图提示运动感觉传导速度均减慢 ;神经活检证实同时有脱髓鞘和轴索变性。甲状腺功能亢进控制后肌无力明显改善 ,神经传导速度亦明显恢复。结论 甲状腺功能亢进可并发周围神经病 ,但较罕见 ,其机制可能为自身免疫和代谢异常 。

Objectives To investigate the clinical manifestations,pathogenesis, electrophysiological and pathological characteristics, treatment and prognosis of hyperthyroidism complicated with polyperipheral neuropathy.Methods Detailed history, pathophysiological examinations and 8 months follow up data were done. Thyroid function was measured dynamically. Electromyogram were performed before and 8 months after the treatment of hyperthyroidism. Sural nerve biopsy specimens were observed under electromicroscope.Results This case as motor sensory polyperipheral neuropathy reflected more motor than sensory and more at distal than proxymal. Electromyogram indicated both motor and sensory conduction velocity were reduced. Demyelination and axonal degeneration were confirmed electromicroscopicaly through sural nerve biopsy. The symptoms and signs of neuropathy were disappeared and the nerve conduction velocity were almost normal after eight months proper treatment of hyperthyroidism.Conclusions Hyperthyroidism might rarely complicated with polyperipheral neuropathy. The mechanism of this type neuropathy might be related to abnormalities of autoimmunity and metabolism. Its prognosis is closely related with the proper treatment of hyperthyroidism.