Electroneuromyography and neuromuscular findings in 16 primary hypothyroidism patients

Cruz, Márcia W.; Tendrich, Mauro; Vaisman, Mário; Novis, Sérgio A. P.

doi:10.1590/S0004-282X1996000100002

Abstracts

There has been few reports on electroneuromyography (ENMG) changes in hypothyroidism. The objectives of the present study were to investigate the frequency of ENMG abnormalities in hypothyroidism and correlate them with neurological signs and symptoms and muscle enzyme levels; and to compare latency, amplitude and nerve conduction velocity from selected nerves with controls. Sixteen patients suffering from primary hypothyroidism were submitted to ENMG before treatment. ENMG abnormalities were found in 87.5% of the patients; 46.6% had myopathy and 43.7% had carpal tunnel syndrome. There was no case of polyneuropathy. A clear-cut clinical, laboratorial and ENMG correlation was observed in patients with myopathy and carpal tunnel syndrome. The patients showed a significant tendency of nerve conduction slowness as compared with controls. The findings are in accordance with the well-known nerve and muscle damage in hypothyroidism.

primary hypothyroidism; electroneuromyography; carpal tunnel syndrome; myopathy

Foram avaliados através de eletroneuromiografia (ENMG) 16 pacientes com hipotireoidismo primário de diversas etiologias, virgens de tratamento, com o objetivo de: estabelecer a incidência de alterações; correlacioná-las com parâmetros clínicos referentes ao acometimento do sistema nervoso periférico e níveis de enzimas musculares; estabelecer a comparação entre valores médios da latência, amplitude e velocidade de condução nervosa de alguns nervos selecionados no grupo de pacientes e de grupo controle. Alterações da ENMG foram encontradas em 87,5% dos casos, sendo estabelecido diagnóstico eletrofisiológico de miopatia em 46,6% e de síndrome do túnel do carpo em 43,7%. Nenhum dos casos foi identificado como polineuropatia. A concordância entre sintomatologia (100%), exame neurológico (28,57%), níveis de enzimas musculares (42,85%) e ENMG foi elevada para casos de miopatia. Nos casos de síndrome do canal carpiano foi respectivamente de 71,42% para sintomatologia e 71,42% para exame neurológico. A comparação de valores médios dos parâmetros selecionados de neurocondução, entre pacientes e controle, demonstrou tendência generalizada à lentificação da condução nervosa no hipotireoidismo primário. A literatura revista concorda com os dados dos autores em relação à extensão do dano de nervo e músculo nessa endocrinopatia.

hipotireoidismo primário; eletroneuromiografia; síndrome do túnel do carpo; miopatia

Márcia W. Cruz^I; Mauro Tendrich^II; Mário Vaisman^II; Sérgio A. P. Novis^I

^INeurology Department, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro

^IIEndocrinology Department, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro

ABSTRACT

There has been few reports on electroneuromyography (ENMG) changes in hypothyroidism. The objectives of the present study were to investigate the frequency of ENMG abnormalities in hypothyroidism and correlate them with neurological signs and symptoms and muscle enzyme levels; and to compare latency, amplitude and nerve conduction velocity from selected nerves with controls. Sixteen patients suffering from primary hypothyroidism were submitted to ENMG before treatment. ENMG abnormalities were found in 87.5% of the patients; 46.6% had myopathy and 43.7% had carpal tunnel syndrome. There was no case of polyneuropathy. A clear-cut clinical, laboratorial and ENMG correlation was observed in patients with myopathy and carpal tunnel syndrome. The patients showed a significant tendency of nerve conduction slowness as compared with controls. The findings are in accordance with the well-known nerve and muscle damage in hypothyroidism.

Key words: primary hypothyroidism, electroneuromyography, carpal tunnel syndrome, myopathy.

RESUMO

Foram avaliados através de eletroneuromiografia (ENMG) 16 pacientes com hipotireoidismo primário de diversas etiologias, virgens de tratamento, com o objetivo de: estabelecer a incidência de alterações; correlacioná-las com parâmetros clínicos referentes ao acometimento do sistema nervoso periférico e níveis de enzimas musculares; estabelecer a comparação entre valores médios da latência, amplitude e velocidade de condução nervosa de alguns nervos selecionados no grupo de pacientes e de grupo controle. Alterações da ENMG foram encontradas em 87,5% dos casos, sendo estabelecido diagnóstico eletrofisiológico de miopatia em 46,6% e de síndrome do túnel do carpo em 43,7%. Nenhum dos casos foi identificado como polineuropatia. A concordância entre sintomatologia (100%), exame neurológico (28,57%), níveis de enzimas musculares (42,85%) e ENMG foi elevada para casos de miopatia. Nos casos de síndrome do canal carpiano foi respectivamente de 71,42% para sintomatologia e 71,42% para exame neurológico. A comparação de valores médios dos parâmetros selecionados de neurocondução, entre pacientes e controle, demonstrou tendência generalizada à lentificação da condução nervosa no hipotireoidismo primário. A literatura revista concorda com os dados dos autores em relação à extensão do dano de nervo e músculo nessa endocrinopatia.

Palavras-chave: hipotireoidismo primário, eletroneuromiografia, síndrome do túnel do carpo, miopatia.

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Aceite: 11-setembro-1995.

Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro.

Dra. Marceia Waddington Cruz - Rua Conselheiro Paulino 348 - 21073-240 Rio de Janeiro RJ - Brasil.

1. AAEM Guideliness in electrodiagnostic medicine. Muscle and Nerve 1992; 15:229-253.
2. Beghi E, Delodovici ML, Bogliun G, Crespi V, Paleari F, Gamba P, Carpa M, Zarreli M. Hypothyroidism and polyneuropathy. J Neurol Neurosurg and Psychiatry 1989; 52:1420-1423.
3. Buge A, Martier M. Manifestations musculaires de l'hypothyróidie. Rev Practic, 1968; 18:2184.
4. Crevasse LE, Logue RB. Peripheral neuropathy in myxedema. Ann Intern Med 1959; 50:1433-1437.
5. Cruz MW, Tendrich M, Mattos JP, Vaisman M, Novis SAP. ENMG study in primary hypothyroidism. Can J Neurol Sci 1993, (Suppl 4):S27.
6. Fessel WJ. Myopathy of hypothyroidism. Ann Rheum Dis 1968, 27:590-596.
7. Fincham RW, Cape CA. Neuropathy in myxedema, Arch Neurol 1968; 19:464-466.
8. Kimura J. Electrodiagnosis in diseases of nerve and muscle: principles and practice, Ed 2 Philadelphia: FA Davis, 1989.
9. Klein I, Parker M, Shebert R, Ayyar DR, Levey GS. Hypothyroidism presenting as muscle stiffness and pseudohypertrophy: Hoffman's syndrome. Am J Med, 1981; 70:891-894.
10. Klein I, Levey GS. Unusual manifestations of hypothyroidism. Arch Intern Med 1984, 144:123-128.
11. Lagueny A, Manciet G, Vital A, Ferrer X, Julien J. Neuropathie hypothyroidienne. Rev Neurol (Paris) 1990; 146:205-210.
12. Leroche M, Testut MF, Clanet M, Guirand-Chaumeil B, Rascol A. Neuropathie périphérique hypothyroidiene. Sem Hôp Paris 1986; 62:1153-1156.
13. Martin J, Tomkin GH, Hutchinson M. Peripheral neuropathy in hypothyroidism, an association with spurious polycythaemia (Gaisbock's syndrome). J R Soc Med, 1983; 76:187-189.
14. McKeran RO, Slavin G, Ward P, Paul E, Main WGP. Hypotyroid myopathy: a clinical and pathological study. J Pathol, 1980; 132:35-54.
15. Meier C, Bischoff A. Polyneuropathy in hypothyroidism: clinical and nerve biopsy study of four Cases. J Neurol 1977; 215:103-114.
16. Murray IPC, Simpson JA. Acroparaesthesia in myxoedema: a clinical and electromyographic study. Lancet 1958, 1:1360-1363.
17. Nemni R, Bottacchi E, Fazio R, Mamoli A, Corbo M, Camerlingo M, Galandi G, Erenbourg L, Canal N. Polyneuropathy in hypothyroidism clinical, electrophysiological and morphological findings in four cases. J Neurol Neurosurg Psychiatry 1987; 50:1454-1460.
18. Nickel SN, Frame B, Bebin J, Tourtellotte WW, Parker JA, Hughes BR. Myxedema neuropathy and myopathy: a Clinical and pathologic study. Neurology 1961, 11:125-137.
19. Pandolfi C, Filippi C. Sindrome di Guillain-Barré associata a ipotiroidismo. Min Med, 1989; 80:1129-1131.
20. Rao SN, Katiyar BC, Nair KRP, Missa S. Neuromuscular status in hypothyroidism. Acta Neurol Scand, 1980; 61:167-177.
21. Salvarani C, Marcello N, Macchioni P, Guidetti D, Rossi F, Iori I, Baricchi R, Ghirclli L, Postioli I. Hypothyroidism simulating polymyositis, J Neurol Neurosurg Psychiatry 1988; 17:147-149.
22. Scarpalezos S, Lygidakis C, Papageorgiou C, Maliara S, Koukoulommati AS, Kontras DA. Neural and muscular manifestations of hypothyroidism. Arch Neurol 1973; 29:140-144.
23. Shirabe T, Tawara S, Terao A, Araki S. Myxoedematous polyneuropathy: a light and electron microscopic study of the peripheral nerve and muscle. J Neurol Neurosurg Psychiatry 1975; 38:241-247.
24. Torres CF, Moxley RT. Hypothyroid neuropathy and myopathy: clinical and electrodiagnostic longitudinal findings. J Neurol 1990; 237:271-274.
25. Wladstein SS, Bronsky D, Shifter HB, Oester YT. The electromyogram in myxedema. Arch Intern Med 1958; 101:97-101.
26. Zampollo A, Cristofori E, Zacchetti O, Spreafico A. Casistica clínica. In Tema di neuropatia hipotiroidea. Min Med, 1983, 74:165-172.

Electroneuromyography and neuromuscular findings in 16 primary hypothyroidism patients

Achados eletroneuromiográficos e neuromusculares em 16 pacientes com hipotireoidismo primário

Publication Dates

Publication in this collection
07 Dec 2010
Date of issue
Mar 1996

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

[1] 1. AAEM Guideliness in electrodiagnostic medicine. Muscle and Nerve 1992; 15:229-253.

[2] 2. Beghi E, Delodovici ML, Bogliun G, Crespi V, Paleari F, Gamba P, Carpa M, Zarreli M. Hypothyroidism and polyneuropathy. J Neurol Neurosurg and Psychiatry 1989; 52:1420-1423.

[3] 3. Buge A, Martier M. Manifestations musculaires de l'hypothyróidie. Rev Practic, 1968; 18:2184.

[4] 4. Crevasse LE, Logue RB. Peripheral neuropathy in myxedema. Ann Intern Med 1959; 50:1433-1437.

[5] 5. Cruz MW, Tendrich M, Mattos JP, Vaisman M, Novis SAP. ENMG study in primary hypothyroidism. Can J Neurol Sci 1993, (Suppl 4):S27.

[6] 6. Fessel WJ. Myopathy of hypothyroidism. Ann Rheum Dis 1968, 27:590-596.

[7] 7. Fincham RW, Cape CA. Neuropathy in myxedema, Arch Neurol 1968; 19:464-466.

[8] 8. Kimura J. Electrodiagnosis in diseases of nerve and muscle: principles and practice, Ed 2 Philadelphia: FA Davis, 1989.

[9] 9. Klein I, Parker M, Shebert R, Ayyar DR, Levey GS. Hypothyroidism presenting as muscle stiffness and pseudohypertrophy: Hoffman's syndrome. Am J Med, 1981; 70:891-894.

[10] 10. Klein I, Levey GS. Unusual manifestations of hypothyroidism. Arch Intern Med 1984, 144:123-128.

[11] 11. Lagueny A, Manciet G, Vital A, Ferrer X, Julien J. Neuropathie hypothyroidienne. Rev Neurol (Paris) 1990; 146:205-210.

[12] 12. Leroche M, Testut MF, Clanet M, Guirand-Chaumeil B, Rascol A. Neuropathie périphérique hypothyroidiene. Sem Hôp Paris 1986; 62:1153-1156.

[13] 13. Martin J, Tomkin GH, Hutchinson M. Peripheral neuropathy in hypothyroidism, an association with spurious polycythaemia (Gaisbock's syndrome). J R Soc Med, 1983; 76:187-189.

[14] 14. McKeran RO, Slavin G, Ward P, Paul E, Main WGP. Hypotyroid myopathy: a clinical and pathological study. J Pathol, 1980; 132:35-54.

[15] 15. Meier C, Bischoff A. Polyneuropathy in hypothyroidism: clinical and nerve biopsy study of four Cases. J Neurol 1977; 215:103-114.

[16] 16. Murray IPC, Simpson JA. Acroparaesthesia in myxoedema: a clinical and electromyographic study. Lancet 1958, 1:1360-1363.

[17] 17. Nemni R, Bottacchi E, Fazio R, Mamoli A, Corbo M, Camerlingo M, Galandi G, Erenbourg L, Canal N. Polyneuropathy in hypothyroidism clinical, electrophysiological and morphological findings in four cases. J Neurol Neurosurg Psychiatry 1987; 50:1454-1460.

[18] 18. Nickel SN, Frame B, Bebin J, Tourtellotte WW, Parker JA, Hughes BR. Myxedema neuropathy and myopathy: a Clinical and pathologic study. Neurology 1961, 11:125-137.

[19] 19. Pandolfi C, Filippi C. Sindrome di Guillain-Barré associata a ipotiroidismo. Min Med, 1989; 80:1129-1131.

[20] 20. Rao SN, Katiyar BC, Nair KRP, Missa S. Neuromuscular status in hypothyroidism. Acta Neurol Scand, 1980; 61:167-177.

[21] 21. Salvarani C, Marcello N, Macchioni P, Guidetti D, Rossi F, Iori I, Baricchi R, Ghirclli L, Postioli I. Hypothyroidism simulating polymyositis, J Neurol Neurosurg Psychiatry 1988; 17:147-149.

[22] 22. Scarpalezos S, Lygidakis C, Papageorgiou C, Maliara S, Koukoulommati AS, Kontras DA. Neural and muscular manifestations of hypothyroidism. Arch Neurol 1973; 29:140-144.

[23] 23. Shirabe T, Tawara S, Terao A, Araki S. Myxoedematous polyneuropathy: a light and electron microscopic study of the peripheral nerve and muscle. J Neurol Neurosurg Psychiatry 1975; 38:241-247.

[24] 24. Torres CF, Moxley RT. Hypothyroid neuropathy and myopathy: clinical and electrodiagnostic longitudinal findings. J Neurol 1990; 237:271-274.

[25] 25. Wladstein SS, Bronsky D, Shifter HB, Oester YT. The electromyogram in myxedema. Arch Intern Med 1958; 101:97-101.

[26] 26. Zampollo A, Cristofori E, Zacchetti O, Spreafico A. Casistica clínica. In Tema di neuropatia hipotiroidea. Min Med, 1983, 74:165-172.