Troid fonksiyon bozukluğu bulunan hastalarda karpal tünel sendromu: Ultrasonografik ve elektrofizyolojik değerlendirme

Amaç: Tiroid fonksiyon bozukluğu bulunan hastalarda karpal tünel sendromunun (KTS), ultrasonografi (US) ve elektrofizyolojik testler ile değerlendirilmesi ve bu hastalarda KTS prevalansının araştırılması. Gereç ve Yöntem: Tiroid fonksiyon bozukluğu (23 hipotiroidi, 17 hipertiroidi) olan 40 hastada 78 el bileği yüksek çözünürlüklü US ve elektrofizyolojik testler ile değerlendirildi. Yirmi bir sağlıklı gönüllüde 41 el bileği kontrol grubunu oluşturdu. US’de median sinirin ekojenitesi değerlendirildi ve distal radial düzey (DRD) ve proksimal karpal kemikler (psiform kemik) düzeyinde (PKD) kesitsel alanı ölçüldü. Median sinir alanının 10 mm2 ve üstünde olması KTS ile uyumlu olarak değerlendirildi. US ve elektrofizyolojik testler ile KTS prevalansı hesaplandı. Bulgular: Kontrol grubunda KTS tanısı alan olgu olmadı. US’de DRD ve/veya PKD deki alan ölçümlerinden birine göre, tiroid disfonksiyonlu 6 hastada 8 el bileğine KTS tanısı koyuldu. Bu hastalarda median sinir alanı DRD’de sağda ve solda sırasıyla 11,00 (± 1,82) mm2 ve 9,75 (± 0,96) mm2, PKD’de 13,00 (± 2,45) mm2 ve 12,25 (± ,63) mm2 ölçüldü. KTS’li tüm olgularda median sinirin daha homojen ve hafif hipoekojen izlendiği dikkati çekti. KTS prevalansı US ve elektrofizyolojik testler ile sırasıyla hipotiroidide % 21,7 ve % 17,3; hipertiroidide % 5,9 bulundu. Sonuç: KTS’li olgularda US incelemede median sinirde ekojenite kaybı ve alan artışı saptanabilir. Hipotiroidi KTS için önemli bir risk faktörüdür. US, risk gruplarının taranmasında kullanılabilir.

Carpal tunnel syndrome in patients with thyroid dysfunction: Ultrasonographic and electrophysiologic evaluation

Aim: Our objective was to evaluate the patients with thyroid dysfunction for carpal tunnel syndrome (CTS) with ultrasonography (US) and electrophysiologic tests and to investigate the prevalance of CTS in these patients. Materials and Methods: Seventy eight wrists in 40 patients with thyroid dysfunction (23 hypothyroid, 17 hyperthyroid) underwent US and electrodiagnostic tests. Fourty one wrists in 21 healthy volunteers constituted the control group. The echogenicity of the median nerve was evaluated and the cross-sectional area was measured at the level of distal radius (DRL) and the proximal carpal (os pisiforme) bones (PCL). A median nerve cross-sectional 2 area over 10mm was accepted as compatible with CTS. The prevalance of CTS was calculated. Results: None of the controls were diagnosed with CTS. Eight wrists in 6 patients with thyroid dysfunction were diagnosed with CTS according to the cross-sectional area measured at DRL or PCL with US. The cross-sectional area of the median nerve at DRL on the right and left sides were 11.00 (± 1.82) mm2 and 9.75 (± 0.96) mm 2 respectively. It was 13.00 (± 2.45) mm2 and 12.25 (± 2.63) mm2 at PCL. The median nerve was more homogenous and hypoechogenic in all patients with CTS. The prevalence of CTS was 21.7 % and 17.3 % with US and electrophysological tests respectively among hypothyroid patients and 5.9 % among hyperthyroid patients. Conclusion: Decreased echogenicity of the median nerve and higher cross sectional area can be detected with US in patients with CTS. Hypothyrodism is a prominent risk factor for CTS. US can be used for evaluating risk groups.

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  • 1. Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: A review of the recent literature. Open Orthop J 2012;6:69-76.
  • 2. Ferry S, Hannaford P, Warskyj M, Lewis M, Croft P. Carpal tunnel syndrome: A nested case control study of risk f actors in women. Am J Epidemiol 2000; 151(6):566-74.
  • 3. Nathan PA, Meadows KD, Istvan JA. Predictors of carpal tunnel syndrome: An 11 year study of industrial workers. J Hand Surg 2002;27(4):644-51.
  • 4. Bril V, Perkins BA. Carpal tunnel syndrome in patients with diabetic polyneuropathy. J Peripher Nerv Syst 2000;5(3):180.
  • 5. Palumbo CF, Szabo RM, Olmsted SL. The effects of hypothyroidism and thyroid replacement on the development of carpal tunnel syndrome. J Hand Surg Am 2000;25(4):734-9.
  • 6. Solomon DH, Katz JN, Bohn R, Mogun H, Avorn J. Nonoccupational risk factors for carpal tunnel syndrome. J Gen Intern Med 1999;14(5):310-4.
  • 7. Duyff RF, Van den Bosch J, Laman DM, Van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: A prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry 2000;68(6):750-5.
  • 8. Frymoyer JW, Bland J. Carpal tunnel sendrome in patients with myxedematous arthropaty. J Bone Joint Surg Am 1973;55(1):78-82.
  • 9. Beard L, Kumar A, Estep HL. Bilateral carpal tunnel syndrome caused by Grave’s disease. Arch Intern Med 1985;145(2):345-6.
  • 10. Ijichi S, Niina K, Tara M, et al. Mononeuropathy associated with hyperthyroidism. J Neurol Neurosurg Psych 1990;53 (12):1109- 10.
  • 11. Cruz MW, Tendrich M, Vaisman M, Novis SA. Electromyography and neuromuscular findings in 16 primary hypothyroidism patients. Arq Neuro-Psiquiat 1996;54(1):8-12.
  • 12. Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculo Skelet Disord 2003;4:1-7.
  • 13. Werner RA, Andary M Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011;44(4):597-607.
  • 14. Mhoon JT, Juel VC, Hobson-Webb LD. Median nerve ultrasound as a screening tool in carpal tunnel syndrome: Correlation of cross-sectional area measures with electrodiagnostic abnormality. Muscle Nerve 2012;46(6):871-8.
  • 15. Ziswiler HR, Reichenbach S, Vögelin E, Bachmann LM, Villiger PM, Jüni P. Diagnostic value of sonography in patients with suspected carpal tunnel syndrome: A prospective study. Arthritis Rheum 2005;52(1):304-11.
  • 16. Claes F, Kasius KM, Meulstee J, Verhagen WI. Comparing a new ultrasound approach with electrodiagnostic studies to confirm clinically defined carpal tunnel syndrome: a prospective, blinded study. Am J Phys Med Rehabil 2013;92(11):1005-11.
  • 17. El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: Substantive or complementary tests? Rheumatology (Oxford) 2004;43(7):887-95.
  • 18. Karadağ YS, Karadağ O, Ciçekli E et al. Severity of Carpal tunnel syndrome assessed with high frequency ultrasonography. Rheumatol Int 2010;30(6):761-5.
  • 19. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome. J Clin Epidemiol 1992;45(4):373-6.
  • 20. El-Salem K, Ammari F. Neurophysiological changes in neurologically asymptomatic hypothyroid patients: A prospective cohort study. J Clin Neurophysiol 2006;23(6):568-72.
  • 21. Kececi H, Degirmenci Y. Hormone replacement therapy in hypothyroidism and nerve conduction study. Neurophysiol Clin 2006;36(2):79-83.
  • 22. Çakır M, Samancı N, Balcı N, Balcı MK. Musculoskeletal manifestations in patients with thyroid disease Clin Endocrinol 2003;59(2):162-7.
  • 23. Kumar N, Gadpayle AK, Roshan S. Thyrotoxic myo-neuropathy. J Indian Acad Clin Med 2012;13(3):255-6.
  • 24. Roquer J, Cano JF. Mononeuropathies in thyrotoxicosis. J Neurol Neurosurg Psychiatry 1992;55(4):332.
  • 25. Jablecki CK, Andary MT, Floeter MK, et al. Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002;11(58):1589-92.
  • 26. Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle Nerve 2002;26(6):798-803.
  • 27. Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol 1999;173(3):681-4.
  • 28. Wong SM, Griffith JF, Hui ACF, Tang A, Wong KS. Discrimantory sonografic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 2002;46(7):1914-21.
  • 29. Sernik RA, Abicalaf CA, Pimental BF, Baiak AB, Braga L, Cerri GG. Ultrasound features of carpal tunnel syndrome: A prospective case-control study. Skeletal Radiol 2008;37(1):49-53.
  • 30. Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: A critical rewiew of the literature. Muscle Nerve 2003;27(1):26-33.
  • 31. Eslamian F, Bahrami A, Aghamohammadzadeh N, Niafar M, Salekzamani Y, Behkamrad K. Electrophysiologic changes in patients with untreated primary hypothyroidism. J Clin Neurophysiol 2011;28(3):323-8.
  • 32. Misiunas A, Niepomniszcze H, Ravera B, Faraj G, Faure E. Peripheral neuropathy in subclinical hypothyroidism. Thyroid 1995;5(4):283-6.
Ege Tıp Dergisi-Cover
  • ISSN: 1016-9113
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1962
  • Yayıncı: Ersin HACIOĞLU