Neurological Sciences

, Volume 30, Issue 2, pp 149–151

Painful neuropathy in subclinical hypothyroidism: clinical and neuropathological recovery after hormone replacement therapy

  • Paola Penza
  • Raffaella Lombardi
  • Francesca Camozzi
  • Claudia Ciano
  • Giuseppe Lauria
Case Report

Abstract

We describe a 60-year-old woman complaining of severe burning feet for 3 months. A neurological examination showed absent Achilles tendon reflexes; nerve conduction study demonstrated mild sensory neuropathy, and skin biopsy revealed a length-dependent loss of intraepidermal nerve fibres. Haematological exams demonstrated a subclinical hypothyroidism and hormone replacement therapy was started. Conversely, symptomatic treatments for neuropathic pain were withdrawn after few days because of side effects. During the following months, thyroid function recovered, and the patient experienced a progressive decrease of neuropathic pain intensity. At 6- and 12-month follow-ups, nerve conduction study and clinical examination were normal, whereas skin biopsy demonstrated a complete reinnervation of the epidermis. Subclinical hypothyroidism is a possible cause of sensory neuropathy and hormone replacement therapy can prompt nerve regeneration.

Keywords

Painful neuropathy Nerve regeneration Skin biopsy Thyroid Nerve conduction study 

References

  1. 1.
    Cruz MW, Tendrich M, Vaisman M, Novis SA (1996) Electroneuromyography and neuromuscular findings in 16 primary hypothyroidism patients. Arq Neuropsiquiatr 54(1):12–18PubMedGoogle Scholar
  2. 2.
    Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH (2000) Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry 68(6):750–755PubMedCrossRefGoogle Scholar
  3. 3.
    Ferreira AA, Nazario JC, Pereira PJ, Azevedo NL, Barradas PC (2004) Effects of experimental hypothyroidism on myelin function sheath structural organization. J Neurocytol 33:225–231PubMedCrossRefGoogle Scholar
  4. 4.
    Khedr EM, El Toony LF, Tarkhan MN, Abdella G (2000) Peripheral and central nervous system alterations in hypothyroidism: electrophysiological findings. Neuropsychobiology 41:88–94PubMedCrossRefGoogle Scholar
  5. 5.
    Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G et al (2008) The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain 131(7):1912–1925PubMedCrossRefGoogle Scholar
  6. 6.
    Nemni R, Bottacchi E, Fazio R, Mamoli A, Corbo M, Camerlingo M et al (1987) Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases. J Neurol Neurosurg Psychiatry 50(11):1454–1460PubMedCrossRefGoogle Scholar
  7. 7.
    Ørstavik K, Norheim I, Jørum E (2006) Pain and small-fiber neuropathy in patients with hypothyroidism. Neurology 67:786–791PubMedCrossRefGoogle Scholar
  8. 8.
    Misiunas A, Niepomniszcze H, Ravera B, Faraj G, Faure E (1995) Peripheral neuropathy in subclinical hypothyroidism. Thyroid 5:283–286PubMedCrossRefGoogle Scholar
  9. 9.
    Ozata M, Ozkardes A, Corakci A, Gundogan MA (1995) Subclinical hypothyroidism does not lead to alterations either in peripheral nerves or in brainstem auditory evoked potentials (BAEPs). Thyroid 5(3):201–205PubMedGoogle Scholar
  10. 10.
    Kececi H, Degirmenci Y (2006) Hormone replacement therapy in hypothyroidism and nerve conduction study. Clin Neurophysiol 36:79–83CrossRefGoogle Scholar
  11. 11.
    Herrmann DN, McDermott MP, Sowden JE, Henderson D, Messing S, Cruttenden K et al (2006) Is skin biopsy a predictor of transition to symptomatic HIV neuropathy? A longitudinal study. Neurology 66(6):857–861PubMedCrossRefGoogle Scholar
  12. 12.
    Sorensen L, Molyneaux L, Yue DK (2006) The relationship among pain, sensory loss, and small nerve fibers in diabetes. Diabetes care 29(4):883–887PubMedCrossRefGoogle Scholar
  13. 13.
    Smith AG, Russell J, Feldman EL, Goldstein J, Peltier A, Smith S et al (2006) Lifestyle intervention for pre-diabetic neuropathy. Diabetes care 29(6):1294–1299PubMedCrossRefGoogle Scholar
  14. 14.
    Nodera H, Barbano RL, Henderson D, Herrmann DN (2003) Epidermal reinnervation concomitant with symptomatic improvement in a sensory neuropathy. Muscle Nerve 27(4):507–509PubMedCrossRefGoogle Scholar
  15. 15.
    Sommer C, Lauria G (2007) Skin biopby in the management of peripheral neuropathy. Lancet Neurol 6(7):632–642PubMedCrossRefGoogle Scholar
  16. 16.
    Attal N, Cruccu G, Haanpaa M, Hansson P, Jensen TS, Nurmikko T et al (2006) EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 13(11):1153–1169PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Paola Penza
    • 1
  • Raffaella Lombardi
    • 1
  • Francesca Camozzi
    • 1
  • Claudia Ciano
    • 2
  • Giuseppe Lauria
    • 1
  1. 1.Neuromuscular Diseases UnitNational Neurological Institute “Carlo Besta”MilanItaly
  2. 2.Neurophysiological UnitNational Neurological Institute “Carlo Besta”MilanItaly

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