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PRIMARY HYPOTHYROIDISM - CHARACTERISTICS OF PERIPHERAL NERVOUS
SYSTEM DAMAGE
Abdukadirova D.T. , Kayumova N.K., Vaxobov S.G.
Andijan State Medical Institute
Department of Neurology
Resume:
The cause of thyroid dysfunction had a dominant effect on the occurrence of
polyneuropathy: in female patients with primary hypothyroidism, polyneuropathy was much
more common and was more pronounced than in male patients.
Key words:
primary hypothyroidism, polyneuropathy.
Introduction.
Currently, thyroid diseases occupy the first place among endocrine pathologies in
terms of their prevalence. Hypothyroidism is one of the most common diseases of the thyroid
gland. Deficiency of thyroid hormones leads to inhibition of metabolism involving all organs and
systems in the pathological process, including the nervous system with the development of
various neurological disorders. These disorders belong to the group of potentially reversible
disorders, which determines a positive prognosis regarding the results of their treatment (1, 2).
Damage to the neuromuscular system is one of the most common complications of
hypothyroidism and thyrotoxicosis. Neuromuscular syndromes of hypothyroidism include
polyneuropathy, myopathy, tunnel neuropathy, pseudomyotonic and pseudomyasthenic
syndromes, thyrotoxicosis is characterized by various types of polyneuropathy and myopathy, in
addition, thyrotoxicosis can be complicated by the development of thyrotoxic hypokalemic
paralysis and provoke the occurrence of myasthenia gravis (3,4). There is no clear opinion about
the pathogenesis, correlation with hormonal status and the state of the neuromuscular system
during the period of compensation of the underlying disease.
Objective:
to identify the clinical features of peripheral neuropathies in primary
hypothyroidism, depending on gender.
Materials and methods.
50 patients with primary hypothyroidism aged 18 to 59 years
were examined, with an average age of 38.2+7.6 years. Patients of the Department of
Endocrinology and Neurology of the Andijan State Medical Institute were taken under
observation. The patients were observed at the Department of Endocrinology and Neurology of
ASMI. The cause of primary hypothyroidism in all patients was autoimmune thyroiditis. All
patients signed an informed consent to participate in the study.
Thus, the criteria for inclusion in the study were: age from 18 to 59 years, the presence of
subclinical hypothyroidism and manifest hypothyroidism. Patients with psychiatric and severe
somatic and thyroid diseases accompanied by a history of thyrotoxicosis syndrome, menopausal
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syndrome requiring hormone replacement therapy with estrogens, diabetes mellitus, autoimmune
polyendocrine syndrome, pregnant and lactating women were excluded from the study.
Table 1
Distribution of patients by groups and subgroups
Groups
sex
subgroups
Forms
of
hypothyroidis
m
n
%
I group
female
А-subgroup
manifest
hypothyroidism 20
66,7 %
(n=30), 60 %
Б- subgroup
subclinical
hypothyroidism 10
33,3%
II group
male
А- subgroup
manifest
hypothyroidism 15
75 %
(n=20), 40 %
Б- subgroup
subclinical
hypothyroidism 5
25 %
Total
patients
with
manifest
hypothyroidism
35
70 %
Total patients with subclinical hypothyroidism
15
30 %
Total
50
100,00%
Depending on the gender, the patients were divided into 2 groups. The first group
included 30 (60%) female patients, and the second group included 20 (40%) male patients. Each
group was divided into 2 subgroups depending on the form of primary hypothyroidism.
Subgroup "A" - 35 consisted of patients with a manifest form of hypothyroidism, subgroup "B"-
15 consisted of patients with a subclinical form of hypothyroidism. The "A" subgroup of group I
included 20 (66.7%) patients, the "A" subgroup of group II – 15 (75%). The "B" subgroup of
group I included 10 (33.3%) patients, the "B" subgroup of group II – 5 (25%). The control group
consisted of 20 healthy individuals, comparable to the main groups by gender and age.
The examined patients with primary hypothyroidism ranged in age from 48 to 59 years.
The average age of women was 42.1±11.7 years, the average age of men was 48.2±8.3 years
(p>0.05).
All patients underwent a standard clinical and neurological examination (analysis of
patient complaints, life history and medical history, objective examination, including the study of
neurological status) and somatic examination.
The severity of polyneuropathy was assessed using an augmented scale for assessing the
clinical severity of polyneuropathy by V.A. Bulanova. The clinical neuropathy index as the sum
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of the scores of the signs of polyneuropathy. The clinical neuropathy index from 1 to 6.5 points
corresponded to mild severity of polyneuropathy syndrome, from 7 to 14.5 points - moderate and
from 15 to 20 points - severe.
The results of the study.
The most common peripheral nervous system disorder in
patients with primary hypothyroidism is polyneuropathy. The clinical picture included
complaints of transient low-intensity and moderate-intensity pain and paresthesia in the distal
extremities, and "socks and gloves" type of hypesthesia. Impaired deep sensitivity manifested
itself in the form of difficulty in determining the direction of movement and counting fingers and
toes. Pronounced paresis and paralysis, as well as muscular hypotrophy, were not observed.
Vegetative disorders were also mild and manifested mainly by dry skin of the hands and feet,
mild acrohyperhidrosis and acrocyanosis. All of these symptoms were more pronounced in the
upper extremities. It should be noted that there is no correlation between the severity of
polyneuropathy and the age of patients.
In the group of female hypothyroid patients, polyneuropathy was a more common
syndrome and occurred in 54.7% of cases (20 people). In addition, with hypofunction of the
thyroid gland in women, polyneuropathy was more pronounced (Clinical neuropathy index:
6.52±2.70 points) in contrast to male patients (Clinical neuropathy index: 3.66±3.90 points),
(p<0.001). The data is shown in Figure 1.
In the I-A group, polyneuropathy was almost an obligate condition - in 82.9% (16 people)
of the examined patients, in the I-B subgroup in 18.8% (6 people) of cases. In I-A,
polyneuropathy was mild in 51.2% of cases (10 people), moderate in 31.7% (6 people); no
pronounced polyneuropathy was detected according to the scale used (Fig.1).
Figure 1. The incidence and severity of polyneuropathy depending on the causes of primary
hypothyroidism in the groups.
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The nature of polyneuropathy depended on the severity of thyroid dysfunction. In patients
with subclinical hypothyroidism, polyneuropathy was detected in 18.8% of cases, in patients
with clinical hypothyroidism - in 82.9% of cases. The average Clinical neuropathy index in
women with subclinical hypothyroidism was 6.60±2.60 points, and in patients with clinical
hypothyroidism, the average Clinical Neuropathy Index score was 6.19±2.95.
It was detected in the II-A group of men in 69.6% (9 people) of the examined patients, in
the II-B subgroup in 13.3% (2 people) cases. In II-A, polyneuropathy was mild in 65.2% of cases
(8 people) out of 13 people with polyneuropathy, moderate in 4.3% (1 person) out of 4 people
with polyneuropathy; no pronounced polyneuropathy was detected according to the scale used
(Fig.1). The average polyneuropathy in patients with primary hypothyroidism was 6.47±2.54
points. Movement disorders were represented by a decrease in tendon and periosteal reflexes,
and only 13.8% (4 people) had a decrease in hand strength of up to 4 points.
Thus
, a feature of the clinical picture of polyneuropathy in male patients with primary
hypothyroidism was mainly its sensitive nature, mild and moderate manifestations, more
pronounced in the hands. The cause of thyroid dysfunction had a dominant effect on the
occurrence of this syndrome: in female patients with primary hypothyroidism, polyneuropathy
was much more common and was more pronounced. In patients, the incidence and severity of
polyneuropathy were associated with varying degrees of hypothyroidism severity.
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