Dados do Trabalho

Título

CASE REPORT: THYROTOXIC SYNDROME MANIFESTING WITH UNUSUAL PERIPHERAL NEUROPATHY

Apresentação do caso único

A 7-year-old previously healthy male patient was admitted to the emergency room complaining of pain in his extremities, associated with seizures. 15 days previous to admission, presented symptoms of burning pain, initially in the palms of the hands, progressing to the soles of the feet with an increase in frequency and intensity. Few days after the beginning of the symptoms, he presented the first episode of seizure. On the following days, pain worsened, with little response to medication, along with persistent arterial hypertension and tachycardia. Workup was performed, with head CT, EEG, echocardiogram, electrolytes and screening for infectious diseases, including CSF with viral panel, all normal. Laboratory workup showed altered thyroid function (TSH 0,868 and free T4 3,22) meeting criteria for thyrotoxic crisis. Propranolol, hydrocortisone and propylthiouracil were started (methimazole not available). Electroneuromyography showed small fiber neuropathy. He presented remission of seizures and gradual improvement in his pain condition with the use of carbamazepine, gabapentin, phenytoin, tramadol and medications aimed at the endocrinological condition.

Discussão

Hyperthyroidism occurs due to an excessive circulation of thyroid hormone. In children, the symptoms are often insidious and similar to those in adult hyperthyroidism, with added growth and developmental impairment. Neurologic manifestations can occur and may include movement disorders (mainly tremor), cognitive dysfunction, proximal muscle weakness, and alterations due to electrolyte disbalance (such as thyrotoxic periodic paralysis). Peripheral neuropathy has been described, but there is little information regarding its physiopathological correlation with thyrotoxicosis as well as few cases described.

Comentários finais

The correlation of hyperthyroidism and peripheral neuropathy, even though not well established, has been described as a rare event in adult patients and even rarer in the pediatric population. It is believed to be also involved in the more common manifestation of proximal muscle weakness. The patient in question presented with neuropathic pain as one of the main primary symptoms, had electrophysiological confirmation of neuropathy, and evolved with improvement of manifestations after specific endocrinologic treatment, which reinforces the probability of endocrinologic involvement on the neuropathy.

Referências

1. Aszalós, Z. (2007). Some neurological and psychiatric complications in the disorders of the thyroid gland: A pajzsmirigy. Orvosi Hetilap 148, 7, 303-310, Available From: AKJournals https://doi.org/10.1556/oh.2007.27988
2. Nandi-Munshi, D et al. Thyroid-Related Neurological Disorders and Complications in Children. Pediatric Neurology, Volume 52, Issue 4, 373 - 382
3. Mattos VM de barros C, Mattos JP de, Lucca irene, Giorelli PCL. Polineuropatia no curso do hipertireoidismo: relato de um caso. Arq Neuro-Psiquiatr [Internet]. 1984Sep;42(3):282–8. Available from: https://doi.org/10.1590/S0004-282X1984000300013
4. Clare A. Wood-allum, Pamela J. Shaw, Chapter 48 - Thyroid disease and the nervous system, Editor(s): José Biller, José M. Ferro, Handbook of Clinical Neurology, Elsevier, Volume 120, 2014, Pages 703-735, ISSN 0072-9752, ISBN 9780702040870,

Palavras Chave

HYPERTHIROIDISM; PERIPHERAL-NEUROPATHY; NEUROPATHIC PAIN