Yeni hipotiroidi tanısı alan olgularda sinir ileti çalışmaları ve ultrasonografik olarak median sinir kesit alanlarının ölçümü
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda yeni tanı almış hipotiroidili olgularda sinir ileti çalışmaları (SİÇ) ile periferik sinir disfonksiyonlarının değerlendirilmesi, tuzak nöropati veya polinöropati (PNP) sıklığının belirlenmesi ve derecesinin değerlendirilmesi ve özellikle karpal tünelde ultrasonografik olarak median sinir kesit alanlarının ölçülüp elektrofizyolojik parametrelerle korelasyonuna bakılması amaçlanmıştır. Materyal ve Metod: Çalışmamıza Selçuk Üniversitesi Tıp Fakültesi Hastanesi Endokrinoloji polikliniğinde yeni tanı alıp kliniğimize refere edilen ve polinöropati yapabilecek başka bir hastalık öyküsü bulunmayan hipotiroidili 30'u (%85,7) kadın 5'i (%14,3) erkek 35 hasta dahil edildi. Kontrol grubu olarak tıbbi bir hastalık ve ilaç kullanımı olmayan yaş ve cins olarak benzer 30'u kadın 5'i erkek 35 sağlıklı birey alındı. Hipotiroidi grubunun yaş ortalaması 37,40±10,88 yıl, kontrol grubunun yaş ortalaması 37,80±10,35 yıl olup istatistiksel anlamlı farklılık yoktu. Olguların verileri, kontrollerden bilateral olarak kayıtlanan SİÇ ve USG parametreleri ile karşılaştırıldı. Median sinir kesit alanları ile elektrofizyolojik parametrelerle korelasyonuna bakıldı. Bulgular: Çalışmamızda 35 hastanın 8'inde (%22.9) elektrofizyolojik olarak karpal tünel sendromu (KTS) belirlendi, %50'sinde bulgular bilateral KTS ile uyumlu olarak değerlendirildi. KTS saptanan kişilerden 1 tanesinde orta şiddette KTS, diğerleri hafif derece KTS'yi desteklemekteydi, ağır KTS belirlenmedi. Polinöropatiyi destekleyecek anlamlı bir elektrofizyolojik anormallik dikkati çekmedi. Genel olarak değerlendirmede kesin polinöropati tanısını teyit edecek düzeye ulaşmamakla birlikte alt grup analizlerinde izole hafif anormallikler mevcuttu. Median sinir kesit alanları hipotroidi grubunda daha yüksek olmakla birlikte istatistiksel olarak anlamlı farklılık düzeyine ulaşmamaktaydı. Sinir kesit alanları ile VKİ'nin anlamlı pozitif korelasyonu vardı. Sol median duyusal latans ve sol median USKA arasında; sağ median duyusal latans ve sağ median USKA arasında hafif anlamlı pozitif korelasyon belirlendi. Yine sağ median duyusal ileti hızı sağ median USKA arasında hafif anlamlı negatif korelasyon saptandı. TSH ve T4 ile SİÇ ve diğer parametreler arasında anlamlı bir korelasyon dikkati çekmedi. Sonuç: Çalışmamız yeni hipotiroidi tanısı alan olgularda elektrofizyolojik olarak yüksek oranda KTS varlığını ortaya koyarken, anlamlı bir PNP gelişmediğini desteklemektedir. Çalışmamızda hipotiroidili olguların bir kısmında (%17) nöropatik ağrı anketi ile nöropatik ağrı belirlendi ve bunların %66'sında KTS mevcuttu; şikayeti olmasına rağmen diğerlerinde SİÇ normaldi. Bu bulgu bazı olgularda izole ince lif nöropatisi ile ilişkili olabilir. Sinir kesit alanları ile VKİ arasında anlamlı pozitif korelasyon saptanmıştır. Bu durum hipotiroidiye bağlı VKİ artışının sinir kesit alanlarını artırabileceği, dolayısıyla tuzak nöropati gelişimine katkı sağlayabileceği şeklinde speküle edilebilir. Median sinir USG kesit alanları ve SİÇ latansları arasında hafif anlamlı pozitif korelasyon, sağ median duyusal ileti hızı sağ median USKA arasında hafif anlamlı negatif korelasyon belirlenmiştir. Bulgular USG'nin tuzak nöropatilerde KTS tanısında katkısının olabileceğini ve tanıyı destekleyebileceğini düşündürmektedir.
Objective: In our study, it was aimed to evaluate peripheral nerve dysfunctions, to evaluate the frequency and the degree of entrapment neuropathy or polyneuropathy (PNP) in the newly diagnosed patients with hypothyroidism and ultrasonographic measurement of cross-sectional areas (UMCSA) of the median nerve in especially the carpal tunnel and to look for a correlation with electrophysiological parameters. Materials and Methods: In our study, there were 30 females (85.7%) and 5 males (% 37.3) patients. Total 35 patients with hypothyroidism, who were newly diagnosed at the Selçuk University Faculty of Medicine, Endocrinology clinic outpatient and referred to our clinic and who did not have any history of polyneuropathy. As a control group, 35 healthy individuals, 30 female and 5 male, were obtained in terms of without any medical illness and drug use which were similar age and sex. The mean age of the hypothyroid group was 37.40 ± 10.88 years, the mean age of the control group was 37.80 ± 10.35 years, and there was no statistically significant difference. The data of the case group were compared with NCS and USG parameters recorded bilaterally from the control group. Median nerve cross-sectional areas and correlations with the electrophysiological parameters were examined. Results: In our study, Carpal Tunnel Syndrome (CTS) was detected electrophysiologically in 8 (22.9%) of 35 patients, and 50% of the findings were evaluated as compatible with bilateral CTS. One of the people with CTS was diagnosed with moderate severity CTS, while others supported mild CTS. Severe CTS was not determined. No significant electrophysiological abnormality to support polyneuropathy was noted. Overall, the assessment did not reach the level to confirm the diagnosis of definitive polyneuropathy, but isolated mild abnormalities were present in subgroup analyzes. Although the median nerve cross sectional areas were higher in the hypothyroid group, they did not reach statistically significant level of difference. There was a significant positive correlation between the nerve cross-section areas and the BMI. Between left median sensory latency and left median UMCSA; between right median sensory latency and right median UMCSA slightly significant positive correlation was determined. Again, a slightly significant negative correlation was found between right median sensory conduction velocity and right median UMCSA. There was no significant correlation between TSH and T4, NCS and other parameters. Conclusion: Our study supports the highly odds of presence of CTS in electrophysiologically in patients with newly diagnosed hypothyroidism, and supports not significant PNP occuring. In our study, neuropathic pain was determined with a neuropathic pain questionnaire in some of the patients with hypothyroidism (17%), and 66% of them had CTS; NCS was normal in others although they had complaints. This finding may be related to isolated small fiber neuropathy in some cases. A significant positive correlation was found between nerve cross-sectional areas and BMI. This situation can be speculated that increased BMI due to hypothyroidism may increase nerve cross-sectional areas and thus contribute to the development of entrapment neuropathy. Slightly significant positive correlation between median nerve USG cross-sectional areas and NCS latencies, and mild significant negative correlation between right median sensory conduction velocity and right median UMCSA is determined. These findings suggest that USG may be helpful to diagnose and may support the diagnosis of CTS in entrapment neuropathies.
Objective: In our study, it was aimed to evaluate peripheral nerve dysfunctions, to evaluate the frequency and the degree of entrapment neuropathy or polyneuropathy (PNP) in the newly diagnosed patients with hypothyroidism and ultrasonographic measurement of cross-sectional areas (UMCSA) of the median nerve in especially the carpal tunnel and to look for a correlation with electrophysiological parameters. Materials and Methods: In our study, there were 30 females (85.7%) and 5 males (% 37.3) patients. Total 35 patients with hypothyroidism, who were newly diagnosed at the Selçuk University Faculty of Medicine, Endocrinology clinic outpatient and referred to our clinic and who did not have any history of polyneuropathy. As a control group, 35 healthy individuals, 30 female and 5 male, were obtained in terms of without any medical illness and drug use which were similar age and sex. The mean age of the hypothyroid group was 37.40 ± 10.88 years, the mean age of the control group was 37.80 ± 10.35 years, and there was no statistically significant difference. The data of the case group were compared with NCS and USG parameters recorded bilaterally from the control group. Median nerve cross-sectional areas and correlations with the electrophysiological parameters were examined. Results: In our study, Carpal Tunnel Syndrome (CTS) was detected electrophysiologically in 8 (22.9%) of 35 patients, and 50% of the findings were evaluated as compatible with bilateral CTS. One of the people with CTS was diagnosed with moderate severity CTS, while others supported mild CTS. Severe CTS was not determined. No significant electrophysiological abnormality to support polyneuropathy was noted. Overall, the assessment did not reach the level to confirm the diagnosis of definitive polyneuropathy, but isolated mild abnormalities were present in subgroup analyzes. Although the median nerve cross sectional areas were higher in the hypothyroid group, they did not reach statistically significant level of difference. There was a significant positive correlation between the nerve cross-section areas and the BMI. Between left median sensory latency and left median UMCSA; between right median sensory latency and right median UMCSA slightly significant positive correlation was determined. Again, a slightly significant negative correlation was found between right median sensory conduction velocity and right median UMCSA. There was no significant correlation between TSH and T4, NCS and other parameters. Conclusion: Our study supports the highly odds of presence of CTS in electrophysiologically in patients with newly diagnosed hypothyroidism, and supports not significant PNP occuring. In our study, neuropathic pain was determined with a neuropathic pain questionnaire in some of the patients with hypothyroidism (17%), and 66% of them had CTS; NCS was normal in others although they had complaints. This finding may be related to isolated small fiber neuropathy in some cases. A significant positive correlation was found between nerve cross-sectional areas and BMI. This situation can be speculated that increased BMI due to hypothyroidism may increase nerve cross-sectional areas and thus contribute to the development of entrapment neuropathy. Slightly significant positive correlation between median nerve USG cross-sectional areas and NCS latencies, and mild significant negative correlation between right median sensory conduction velocity and right median UMCSA is determined. These findings suggest that USG may be helpful to diagnose and may support the diagnosis of CTS in entrapment neuropathies.
Açıklama
Anahtar Kelimeler
Sinir İletim Çalışmaları, Hipotiroidizm, Nerve Conduction Studies, Hypothyroidism
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yıldoğan, A. T. (2020). Yeni hipotiroidi tanısı alan olgularda sinir ileti çalışmaları ve ultrasonografik olarak median sinir kesit alanlarının ölçümü. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
