Neurological Manifestations of Thyroid Disease Treatment & Management

  • Author: Gabriel Bucurescu, MD, MS; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Oct 17, 2011
 

Medical Care

Neurologic manifestations in thyroid disease generally develop slowly. They are diagnosed months or years after initial endocrine problems.

  • Patients seek care after developing characteristic systemic signs and symptoms.
  • Polyneuropathy is rarely the initial manifestation of undetected hypothyroidism. Metastatic thyroid carcinoma rarely presents as an initial brain metastatic lesion.
  • Chorea-ballism has been reported sporadically. Chorea has been associated with elevated levels of antithyroid antibodies, with the symptoms responding to oral steroid treatment.
  • Interestingly, one study reports that mild hypothyroidism is associated with better survival of ambulatory elderly patients after acute stroke.[8]
  • Several reports of intracranial vascular disease (arterial occlusion, superior sagittal sinus thrombosis, cerebral vein thrombosis) have been reported associated with both hypothyroidism and hyperthyroidism. However, the patients had multiple pathologies, and a clear correlation with thyroid disease is difficult to establish.[9, 10, 11]
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Surgical Care

Surgery is indicated in the treatment of thyroid masses and large goiters.

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Consultations

  • Internal medicine/endocrinologist
  • Head and neck surgeon
  • Nuclear medicine specialist
  • Radiation oncologist
  • Pathologist
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Diet

Iodine deficiency is not widespread in the United States, although immigrants from areas of endemic deficiency may require dietary consultation. Pregnant women may require more careful screening.

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Activity

No restrictions are recommended typically.

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Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Gabriel Bucurescu, MD, MS  Staff Neurologist, Neurology Service, Philadelphia Veterans Affairs Medical Center

Gabriel Bucurescu, MD, MS is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, and American Epilepsy Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas A Kent, MD  Professor and Director of Stroke Research and Education, Department of Neurology, Baylor College of Medicine; Chief of Neurology, Michael E DeBakey Veterans Affairs Medical Center

Thomas A Kent, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, New York Academy of Sciences, Royal Society of Medicine, Sigma Xi, and Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Agapito S Lorenzo, MD  Laboratory Director, Associate Professor, Departments of Neurology, Creighton University and University of Nebraska Medical Center

Agapito S Lorenzo, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD  Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

References

  1. Guimaraes J, Santos L, Bugalho P. Painful legs and moving toes syndrome associated with Hashimoto's disease. Eur J Neurol. Mar 2007;14(3):343-5. [Medline].

  2. Chia SY, Chua R, Lo YL, Wong MC, Chan LL, Tan EK. Acute ataxia, Graves' disease, and stiff person syndrome. Mov Disord. Oct 15 2007;22(13):1969-71. [Medline].

  3. Ohba S, Nakagawa T, Murakami H. Concurrent Graves' disease and intracranial arterial stenosis/occlusion: special considerations regarding the state of thyroid function, etiology, and treatment. Neurosurg Rev. Jul 2011;34(3):297-304; discussion 304. [Medline].

  4. Scorza FA, Arida RM, Cysneiros RM, Terra VC, de Albuquerque M, Machado HR. Subclinical hyperthyroidism and sudden unexpected death in epilepsy. Med Hypotheses. Apr 2010;74(4):692-4. [Medline].

  5. Blanchin S, Coffin C, Viader F, Ruf J, Carayon P, Potier F, et al. Anti-thyroperoxidase antibodies from patients with Hashimoto's encephalopathy bind to cerebellar astrocytes. J Neuroimmunol. Dec 2007;192(1-2):13-20. [Medline].

  6. Sellner J, Kalluri SR, Cepok S, Hemmer B, Berthele A. Thyroid antibodies in aquaporin-4 antibody positive central nervous system autoimmunity and multiple sclerosis. Clin Endocrinol (Oxf). Aug 2011;75(2):271-2. [Medline].

  7. Sinclair C, Gilchrist JM, Hennessey JV, Kandula M. Muscle carnitine in hypo- and hyperthyroidism. Muscle Nerve. Sep 2005;32(3):357-9. [Medline].

  8. Alevizaki M, Synetou M, Xynos K, Alevizaki CC, Vemmos KN. Hypothyroidism as a protective factor in acute stroke patients. Clin Endocrinol (Oxf). Sep 2006;65(3):369-72. [Medline].

  9. Dai A, Wasay M, Dubey N, Giglio P, Bakshi R. Superior sagittal sinus thrombosis secondary to hyperthyroidism. J Stroke Cerebrovasc Dis. Mar-Apr 2000;9(2):89-90. [Medline].

  10. Ni J, Gao S, Cui LY, Li SW. Intracranial arterial occlusive lesion in patients with Graves' disease. Chin Med Sci J. Sep 2006;21(3):140-4. [Medline].

  11. Peralta AR, Canhão P. Hypothyroidism and cerebral vein thrombosis--a possible association. J Neurol. Jul 2008;255(7):962-6. [Medline].

  12. Adams RD, Victor M, Ropper AH. The endocrine myopathies. In: 6th ed. Principles of Neurology. 1997. New York: McGraw-Hill; 1440-2.

  13. Ahdab R, Thomas D. Palatal tremor, focal seizures, repeated miscarriages and elevated anti-thyroid antibodies. Clin Neurol Neurosurg. Apr 2008;110(4):381-3. [Medline].

  14. Avramides A, Papamargaritis K, Mavromatis I, et al. Visual evoked potentials in hypothyroid and hyperthyroid patients before and after achievement of euthyroidism. J Endocrinol Invest. 1992;15:749-753. [Medline].

  15. Boyages SC, Halpern J-P. Endemic cretinism: toward a unifying hypothesis. Thyroid. 1993;3(1):59-69. [Medline].

  16. Calza L, Aloe L, Giardino L. Thyroid hormone-induced plasticity in the adult rat brain. Brain Res Bull. 1997;44(4):549-57. [Medline].

  17. Chang T, Riffsy MT, Gunaratne PS. Hashimoto encephalopathy: clinical and MRI improvement following high-dose corticosteroid therapy. Neurologist. Nov 2010;16(6):394-6. [Medline].

  18. Comi AM, Bellamkonda S, Ferenc LM, Cohen BA, Germain-Lee EL. Central hypothyroidism and Sturge-Weber syndrome. Pediatr Neurol. Jul 2008;39(1):58-62. [Medline].

  19. DeLong GR. The neuromuscular system and brain in hypothyroidism. In: Braverman LE, Utiger RD, eds. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 7th ed. Philadelphia: Lippincott-Raven; 1996:826-35.

  20. DeLong GR. The neuromuscular system and brain in thyrotoxicosis. In: Braverman LE, Utiger RD, eds. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 7th ed. Philadelphia: Lippincott-Raven; 1996:645-52.

  21. Donati L, Antonelli A, Bertoni F, et al. Clinical picture of endemic cretinism in central Apennines (Montefeltro). Thyroid. 1992;2(4):283-290. [Medline].

  22. Duhig TJ, McKeag D. Thyroid disorders in athletes. Curr Sports Med Rep. Jan-Feb 2009;8(1):16-9. [Medline].

  23. Ferracci F, Carnevale A. The neurological disorder associated with thyroid autoimmunity. J Neurol. Aug 2006;253(8):975-84. [Medline].

  24. Halpern J-P, Boyages SC, Maberly GF, et al. The neurology of endemic cretinism. Brain. 1991;114:825-841. [Medline].

  25. Hsieh MJ, Lyu RK, Chang WN, Chang KH, Chen CM, Chang HS, et al. Hypokalemic thyrotoxic periodic paralysis: clinical characteristics and predictors of recurrent paralytic attacks. Eur J Neurol. Jun 2008;15(6):559-64. [Medline].

  26. Jagannathan NR, Tandon N, Raghunathan P, Kochupillai N. Reversal of abnormalities of myelination by thyroxine therapy in congenital hypothyroidism: localized in vivo proton magnetic resonance spectroscopy (MRS) study. Brain Res Dev Brain Res. Aug 8 1998;109(2):179-86. [Medline].

  27. Kurne A, Aydin OF, Karabudak R. White matter alteration in a patient with Graves' disease. J Child Neurol. Sep 2007;22(9):1128-31. [Medline].

  28. Lai CL, Liu CK, Tai CT, et al. A study of central and peripheral nerve conduction in patients with primary hypothyroidism: the effects of thyroxine replacement. Kaohsiung J Med Sci. May 1998;14(5):294-302. [Medline].

  29. Larsen PR. The thyroid. In: Wyngaarden JB, Smith LH Jr, Bennett JC, et al, eds. Cecil Textbook of Medicine. 19th ed. Philadelphia: Saunders; 1992:1248-71.

  30. Li L, Zheng FP, Wang G, Li H. Recurrent hashimoto's encephalopathy, showing spontaneous remission: a case report. Intern Med. 2011;50(12):1309-12. [Medline].

  31. Losa M, Mortini P, Minelli R, Giovanelli M. Coexistence of TSH-secreting pituitary adenoma and autoimmune hypothyroidism. J Endocrinol Invest. 2006;29:555-559. [Medline].

  32. Madeira MD, Cadete-Leite A, Andrade JP, et al. Effects of hypothyroidism upon the granular layer of the dentate gyrus in male and female adult rats: a morphometric study. J Comp Neurol. Dec 1 1991;314(1):171-86. [Medline].

  33. Marta CB, Adamo AM, Soto EF, Pasquini JM. Sustained neonatal hyperthyroidism in the rat affects myelination in the central nervous system. J Neurosci Res. Jul 15 1998;53(2):251-9. [Medline].

  34. Mavragani CP, Patronas N, Dalakas M, Moutsopoulos HM. Ill-defined neurological syndromes with autoimmune background: a diagnostic challenge. J Rheumatol. Feb 2007;34(2):341-5. [Medline].

  35. Muthipeedika JM, Moosa A, Kumar A, Suchowersky O. Bilateral chorea--ballism associated with hyperthyroidism. Mov Disord. Apr 2005;20(4):512; author reply 512. [Medline].

  36. 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(3):201-205. [Medline].

  37. Ozata M, Ozkardes A, Dolu H, et al. Evaluation of central motor conduction in hypothyroid and hyperthyroid patients. J Endocrinol Invest. 1996;19:670-677. [Medline].

  38. Ozkan Y, Colak R. Sheehan syndrome: clinical and laboratory evaluation of 20 cases. Neuro Endocrinol Lett. Jun 2005;26(3):257-60. [Medline].

  39. Ozkardes A, Ozata M, Beyhan Z, et al. Acute hypothyroidism leads to reversible alterations in central nervous system as revealed by somatosensory evoked potentials. Electroencephalography and clinical neurophysiology. 1996;100:500-504. [Medline].

  40. Parker RJ, Davidson AC. Hypothyroidism--an unexpected diagnosis following emergency treatment for heatstroke. Int J Clin Pract Suppl. Apr 2005;31-3. [Medline].

  41. Perelman AH, Clemons RD. The fetus in maternal hyperthyroidism. Thyroid. 1992;2(3):225-228. [Medline].

  42. Powner DJ, Boccalandro C, Alp MS, Vollmer DG. Endocrine failure after traumatic brain injury in adults. Neurocrit Care. 2006;5(1):61-70. [Medline].

  43. Quattrini A, Nemni R, Marchettini P, et al. Effect of hypothyroidism on rat peripheral nervous system. Neuroreport. 1993;4:499-502. [Medline].

  44. Sahni V, Gupta N, Anuradha S, Tatke M, Kar P. Thyrotoxic neuropathy- an under diagnosed condition. Med J Malaysia. Mar 2007;62(1):76-7. [Medline].

  45. Santoro D, Colombo I, Ghione I, Peverelli L, Bresolin N, Sciacco M. Steroid-responsive Hashimoto encephalopathy mimicking Creutzfeldt-Jakob disease. Neurol Sci. Aug 2011;32(4):719-22. [Medline].

  46. Somay G, Oflazoglu B, Us O, Surardamar A. Neuromuscular status of thyroid diseases: a prospective clinical and electrodiagnostic study. Electromyogr Clin Neurophysiol. Mar-Apr 2007;47(2):67-78. [Medline].

  47. Tamburini G, Tacconi P, Ferrigno P, et al. Visual evoked potentials in hypothyroidism: a long-term evaluation. Electromyogr Clin Neurophysiol. 1998;38:201-205. [Medline].

  48. Tuncel D, Cetinkaya A, Kaya B, Gokce M. Hoffmann's syndrome: a case report. Med Princ Pract. 2008;17(4):346-8. [Medline].

 
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