Doenças da tireoide e miastenia grave

Assis, J. Lamartine de; Scaff, Milberto; Zambon, Antonio A.; Marchiori, Paulo E.

doi:10.1590/S0004-282X1984000300006

Resumos

Os autores estudam o comportamento da tireóide em um grupo de 304 pacientes com miastenia grave, constatando 15 casos de tireopatias, sendo 9 de hipertireoidismo, um de hipotireoidismo e 5 de bócio sem alterações da função tireoidiana. Nenhum paciente era proveniente de região de bócio endêmico e não havia bócio familiar. A tireotoxicose, que foi a disfunção mais frequente, foi estudada quanto a sua prevalência em pacientes miastênicos, quanto a sua influência sobre os sintomas da miastenia grave e quanto à época do seu aparecimento.

In a group of 304 myasthenic patients 15 cases with thyropathies were reported: nine with hiperthyroidism, one with hypothyroidism and five with nontoxic goiter. Four patients presented diffuse simple goiter and one a multinodular goiter with normal thyroid function. No patient came from an endemic goiter region, not even familial goiter. The prevalence and influence of hyperthyroidism on myasthenic symptomatology were studied. Our findings suggest that there is no clinical correlation between both myasthenia symptomatology and thyroid dysfunction, neither significant influence on myasthenic symptoms when the endocrine disorders improve.

Doenças da tireoide e miastenia grave

Thyroid diseases and myasthenia gravis: study of 15 cases

J. Lamartine de Assis^I; Milberto Scaff^II; Antonio A. Zambon^III; Paulo E. Marchiori^III

^IProfessor Adjunto. Departamento de Neuropsiquiatria (Prof. Dr. Horácio Martins Canelas) da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIProfessor Livre Docente. Departamento de Neuropsiquiatria (Prof. Dr. Horácio Martins Canelas) da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIIMédico Assistente do Hospital das Clínicas, FMUSP

RESUMO

Os autores estudam o comportamento da tireóide em um grupo de 304 pacientes com miastenia grave, constatando 15 casos de tireopatias, sendo 9 de hipertireoidismo, um de hipotireoidismo e 5 de bócio sem alterações da função tireoidiana. Nenhum paciente era proveniente de região de bócio endêmico e não havia bócio familiar. A tireotoxicose, que foi a disfunção mais frequente, foi estudada quanto a sua prevalência em pacientes miastênicos, quanto a sua influência sobre os sintomas da miastenia grave e quanto à época do seu aparecimento.

SUMMARY

In a group of 304 myasthenic patients 15 cases with thyropathies were reported: nine with hiperthyroidism, one with hypothyroidism and five with nontoxic goiter. Four patients presented diffuse simple goiter and one a multinodular goiter with normal thyroid function. No patient came from an endemic goiter region, not even familial goiter. The prevalence and influence of hyperthyroidism on myasthenic symptomatology were studied. Our findings suggest that there is no clinical correlation between both myasthenia symptomatology and thyroid dysfunction, neither significant influence on myasthenic symptoms when the endocrine disorders improve.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Trabalho realizado no Serviço de Clínica Neurológica da Divisão de Neurologia do Departamento de Neuropsiquiatria (Prof. Dr. Horácio Martins Canelas) da Faculdade de Medicina da Universidade de São Paulo (FMUSP).

Clinica Neurológica, FMUSP - Caixa Postal 3461 - 01000, São Paulo, SP - Brasil

1. AARLI, J. A.; THUNOLD, S. & HEIMANN, P. - Thyroiditis in myasthenia gravis. Acta neurol. scand. 58:121, 1978.
2. ADNER, M. M.; SHERMAN, J. D.; ISE, C; SCHWAB, R. S. & DAMESHEK, W. - An immunologic survey of 48 patients with myasthenia gravis. New Engl. J. Med. 271:1327, 1964.
3. ASSIS, J. L. - Miastenia grave. In R. Melarangno & C. K. Naspitz (eds.) - Neuroimunologia. Sarvier, São Paulo, 1982, pg 97.
4. BECKER, K. L.; TITUS, J. L.; McCONAHEY, W. M. & WOOLNER, L. B. - Morphologic evidence of thyroiditis in myasthenia gravis. J. amer. med. Assoc. 18:994, 1964.
5. DALT, J. J. & JACKSON, E. - Case of Hashimoto disease with myasthenia gravis. Brit. med. J. 1:748, 1964.
6. DOWNES, J. M.; GREENWOD, B. M. & WRAY, S. H. - Autoimmune aspects of myasthenia. Quart. J. Med. 35:85, 1966.
7. DRACHMAN, D. B. - Myasthenia gravis and thyroid gland. New Engl. J. Med. 266:330, 1962.
8. FELTKAMP, T. E. W.; VAN DEN BERG-LOONEN, P. M.; NIJENHIUS, L. E.; ENGELFRIET, C. P.; VAN ROSSUM, A. L.; VAN LOGHEM, J. J. & OOSTER-HUIS, H. J. G. H. -Myasthenia gravis, autoantibodies and HLA antigens. Brit, med. J. 1:131, 1974.
9. GELTHORPE H. K.; MILFORD-WARD, A. & DAVIES-JONES, G. - Clinical and immunological associations in myasthenia gravis: autoantibodies. J. Neurol. Neurosurg. Psychiat. 43:967, 1980.
10. KIESSLING, W. R.; PFLUGHAUPT, K. W.; RICKER, K.; HAUHITZ, I. & MERTENS, H. G. - Thyroid function and circulating antithyroid antibodies in myasthenia gravis. Neurology (Ny) 31:771, 1981.
11. MEDEIROS NETO, G. A.; ASSIS, J.L.; PIERONI, R. R. & NICOLAU, W. - Miastenia grave e função tireoidiana. Rev. Ass. méd. bras. 10:265, 1964.
12. MILLIKAN, C. H. & HAINES, S. F. - The thyroid gland in relation to neuromuscular disease. Arch. int. Med. 92:5, 1953.
13. NAMBA, T. & GROB, D. - Myasthenia gravis and hyperthyroidism occurring in two sisters. Neurology (Minneapolis) 21:377, 1971.
14. OOSTERHUIS, H. J. G. H. - Studies in myasthenia gravis: a clinical study of 180 patients. J. neurol. Sci. 1:1546, 1964.
15. OSSERMAN, K. E. - Myasthenia Gravis. Grune & Stratton, New York, 1958.
16. OSSERMAN, K. E.; TSAIRIS, P. & WEINER, L. B. - Myasthenia gravis and thyroid disease: clinical and immunologic correlation. J. Mt. Sinai Hosp. 34:469, 1967.
17. RAMSAY, I. - Thyroid Disease and Muscle Dysfunction. Heinemann, London, 1974, pg. 53.
18. ROWLAND, L. P. - Myasthenia Gravis. In B. S. Goldensohn & S. H., Appel (eds.) - Scientific Approaches to Clinical Neurology. Lea & Febiger, Philadelphia, 1977, pg 1018.
19. SIMPSON, J. A. - Myasthenia gravis: a new hypothesis. Scott, med. J. 5:419, 1960.
20. SIMPSON, J. A. - Myasthenia gravis as an autoimmune disease: clinical aspects. Ann. N. Y. Acad. Sci. 135:506, 1966.
21. SIMPSON, J. F.; WESTENBERG, M. R. & MAGEE, H. R. - Myasthenia gravis: an analysis of 295 cases. Acta neurol. scand. 42 (suppl. 23):7, 1966.
22. VAN DER GELD, H.; FELTKAMP, T. E. W.; VAN DER LOGHEM, J. J.; OOSTERHUIS H. J. G. H. & BIEMOND, A. - Multiple antibody production in myasthenia gravis. Lancet 2:373, 1963.
23. WILLIAMSON, H. O.; PHANSEY, S. A.; MATHUR, S.; MATHUR, R. S.; BAKER, E. R. & FTJDENBERG, H. H. - Myasthenia gravis, premature menopause, and thyroid autoimmunity. Amer. J. Obstet. Gynec. 137:893, 1980.
24. WOLF, S. M.; ROWLAND, L. P.; SCHOTLAND, D. L.; McKINNEY, A. S.; HOEFFER, P. F. A. & ARANOW, Jr., H. - Myasthenia as an auto-immune disease: clinical aspects. Ann. N. Y. Acad. Sci. 135:517, 1966.

Datas de Publicação

Publicação nesta coleção
13 Ago 2012
Data do Fascículo
Set 1984

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AARLI, J. A.; THUNOLD, S. & HEIMANN, P. - Thyroiditis in myasthenia gravis. Acta neurol. scand. 58:121, 1978.

[2] 2. ADNER, M. M.; SHERMAN, J. D.; ISE, C; SCHWAB, R. S. & DAMESHEK, W. - An immunologic survey of 48 patients with myasthenia gravis. New Engl. J. Med. 271:1327, 1964.

[3] 3. ASSIS, J. L. - Miastenia grave. In R. Melarangno & C. K. Naspitz (eds.) - Neuroimunologia. Sarvier, São Paulo, 1982, pg 97.

[4] 4. BECKER, K. L.; TITUS, J. L.; McCONAHEY, W. M. & WOOLNER, L. B. - Morphologic evidence of thyroiditis in myasthenia gravis. J. amer. med. Assoc. 18:994, 1964.

[5] 5. DALT, J. J. & JACKSON, E. - Case of Hashimoto disease with myasthenia gravis. Brit. med. J. 1:748, 1964.

[6] 6. DOWNES, J. M.; GREENWOD, B. M. & WRAY, S. H. - Autoimmune aspects of myasthenia. Quart. J. Med. 35:85, 1966.

[7] 7. DRACHMAN, D. B. - Myasthenia gravis and thyroid gland. New Engl. J. Med. 266:330, 1962.

[8] 8. FELTKAMP, T. E. W.; VAN DEN BERG-LOONEN, P. M.; NIJENHIUS, L. E.; ENGELFRIET, C. P.; VAN ROSSUM, A. L.; VAN LOGHEM, J. J. & OOSTER-HUIS, H. J. G. H. -Myasthenia gravis, autoantibodies and HLA antigens. Brit, med. J. 1:131, 1974.

[9] 9. GELTHORPE H. K.; MILFORD-WARD, A. & DAVIES-JONES, G. - Clinical and immunological associations in myasthenia gravis: autoantibodies. J. Neurol. Neurosurg. Psychiat. 43:967, 1980.

[10] 10. KIESSLING, W. R.; PFLUGHAUPT, K. W.; RICKER, K.; HAUHITZ, I. & MERTENS, H. G. - Thyroid function and circulating antithyroid antibodies in myasthenia gravis. Neurology (Ny) 31:771, 1981.

[11] 11. MEDEIROS NETO, G. A.; ASSIS, J.L.; PIERONI, R. R. & NICOLAU, W. - Miastenia grave e função tireoidiana. Rev. Ass. méd. bras. 10:265, 1964.

[12] 12. MILLIKAN, C. H. & HAINES, S. F. - The thyroid gland in relation to neuromuscular disease. Arch. int. Med. 92:5, 1953.

[13] 13. NAMBA, T. & GROB, D. - Myasthenia gravis and hyperthyroidism occurring in two sisters. Neurology (Minneapolis) 21:377, 1971.

[14] 14. OOSTERHUIS, H. J. G. H. - Studies in myasthenia gravis: a clinical study of 180 patients. J. neurol. Sci. 1:1546, 1964.

[15] 15. OSSERMAN, K. E. - Myasthenia Gravis. Grune & Stratton, New York, 1958.

[16] 16. OSSERMAN, K. E.; TSAIRIS, P. & WEINER, L. B. - Myasthenia gravis and thyroid disease: clinical and immunologic correlation. J. Mt. Sinai Hosp. 34:469, 1967.

[17] 17. RAMSAY, I. - Thyroid Disease and Muscle Dysfunction. Heinemann, London, 1974, pg. 53.

[18] 18. ROWLAND, L. P. - Myasthenia Gravis. In B. S. Goldensohn & S. H., Appel (eds.) - Scientific Approaches to Clinical Neurology. Lea & Febiger, Philadelphia, 1977, pg 1018.

[19] 19. SIMPSON, J. A. - Myasthenia gravis: a new hypothesis. Scott, med. J. 5:419, 1960.

[20] 20. SIMPSON, J. A. - Myasthenia gravis as an autoimmune disease: clinical aspects. Ann. N. Y. Acad. Sci. 135:506, 1966.

[21] 21. SIMPSON, J. F.; WESTENBERG, M. R. & MAGEE, H. R. - Myasthenia gravis: an analysis of 295 cases. Acta neurol. scand. 42 (suppl. 23):7, 1966.

[22] 22. VAN DER GELD, H.; FELTKAMP, T. E. W.; VAN DER LOGHEM, J. J.; OOSTERHUIS H. J. G. H. & BIEMOND, A. - Multiple antibody production in myasthenia gravis. Lancet 2:373, 1963.

[23] 23. WILLIAMSON, H. O.; PHANSEY, S. A.; MATHUR, S.; MATHUR, R. S.; BAKER, E. R. & FTJDENBERG, H. H. - Myasthenia gravis, premature menopause, and thyroid autoimmunity. Amer. J. Obstet. Gynec. 137:893, 1980.

[24] 24. WOLF, S. M.; ROWLAND, L. P.; SCHOTLAND, D. L.; McKINNEY, A. S.; HOEFFER, P. F. A. & ARANOW, Jr., H. - Myasthenia as an auto-immune disease: clinical aspects. Ann. N. Y. Acad. Sci. 135:517, 1966.