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The prediction effects of thyroid function in the severity of Guillain-Barré syndrome

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Abstract

Background

Guillain-Barré syndrome (GBS), an acquired immune-mediated inflammatory disorder affecting the peripheral nervous system (PNS), is usually complicated with autoimmune diseases including thyroid diseases. Herein, we explored roles of thyroid function and thyroid autoantibodies in the disease severity and its short-term prognosis of GBS. In addition, we further investigated the predictive value of thyroid function for GBS respiratory insufficiency.

Materials and methods

We retrospectively analyzed the clinical data of 219 GBS patients. According to the thyroid function, the enrolled subjects were divided into 2 groups, that is, patients with abnormal thyroid function (case group) and those with normal thyroid function (control group). The clinical characteristics, disease severity, and short-term prognosis of the patients in 2 groups were compared. In addition, we also divided the 219 GBS patients into mechanical ventilation (MV) group and non-MV group according to whether MV was performed within 1 week after admission. The clinical characteristics, disease severity, short-term prognosis, Erasmus GBS respiratory insufficiency score (EGRIS), and the thyroid function were compared in the two groups.

Results

We found that GBS patients with abnormal thyroid function had longer duration of hospitalization, higher frequency of cranial nerve damage, and higher incidence of weakened tendon reflexes. Medical Research Council (MRC) scores on admission, at nadir, and at discharge were lower, and Hughes Functional Grading Scale (HFGS) scores on admission and at discharge were higher in GBS patients with abnormal thyroid function group. More patients in the abnormal thyroid function group had myelin, axonal, and myelin-axonal injuries. In the MV group, the time from onset to admission, MRC scores on admission, and the levels of free triiodothyronine (FT3) were lower; the levels of thyroglobulin antibody (TgAb) and EGRIS were significantly higher than those in the non-MV group. The combination of EGRIS and FT3 serum levels to predict GBS patients with MV, the area under the curve (AUC) was 0.905 (95% CI: 0.861 to 0.948, P < 0.05), sensitivity was 88.9%, and specificity was 84.7%.

Conclusion

Our results suggest that the serum FT3 levels are negatively correlated with disease severity; the serum FT3 might be a biomarker for the incidence and severity of GBS. Both EGRIS and serum FT3 have a predictive value for the occurrence of acute respiratory insufficiency in GBS patients, and the combination of these two indicators can more accurately predict the risk of acute respiratory insufficiency in GBS patients.

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Abbreviations

GBS:

Guillain-Barré syndrome

FT3:

Free triiodothyronine

FT4:

Free thyroxine

TSH:

Thyroid-stimulating hormone

TPOAb:

Thyroperoxidase antibody

TgAb:

Thyroglobulin antibody

TH:

Thyroid hormone

PNS:

Peripheral nervous system

MV:

Mechanical ventilation

EGRIS:

Erasmus GBS respiratory insufficiency score

MRC:

Medical Research Council

HFGS:

Hughes Functional Grading Scale

CNS:

Central nervous system

OPCs:

Oligodendrocyte precursor cells

MS:

Multiple sclerosis

CIDP:

Chronic inflammatory demyelinating polyneuropathy

IFN-γ:

Interferon γ

TNF-α:

Tumor necrosis factor α

IL-17:

Interleukin-17

ROS:

Reactive oxygen species

ROC:

Receiver operating characteristic

AUC:

Area under the curve

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Funding

This study was supported by grants from The First Hospital, Jilin University, Changchun, China, General Program of the National Natural Science Foundation (No. 81771299).

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Authors and Affiliations

  1. Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, 130021, China

    Lingxin Kong, Xiujuan Wu, Yanwei Cheng, Shan Liu, Kangding Liu & Chunrong Li

  2. Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China

    Chunrong Li

Authors
  1. Lingxin Kong
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  2. Xiujuan Wu
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  3. Yanwei Cheng
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  4. Shan Liu
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Contributions

Experimental design: Chunrong Li. Writing the manuscript and implementation of the experiment: Lingxin Kong. Data analysis: Xiujuan Wu, Yanwei Cheng, Kangding Liu, and Shan Liu.

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Correspondence to Chunrong Li.

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The authors declare no conflicts of interest.

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This study was approved by Ethics Committee of the Neuroscience Center, Department of Neurology, The First Hospital of Jilin University.

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Informed consent was obtained from all patients and their legal representatives.

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Kong, L., Wu, X., Cheng, Y. et al. The prediction effects of thyroid function in the severity of Guillain-Barré syndrome. Neurol Sci 43, 5017–5028 (2022). https://doi.org/10.1007/s10072-022-06070-3

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  • DOI: https://doi.org/10.1007/s10072-022-06070-3

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