Dr No 007

Dr. Nelson Mane Asks, “neuropathy and Hypothyroidism: is There a Connection?”

A disease that most do not commonly associate with peripheral neuropathy is Hypothyroidism.  Many patients present to my office for treatment of peripheral neuropathy and have been worked up for diabetes (the most common cause of Peripheral Neuropathy in the United States) but rarely have had their thyroid checked.  Although this is not a common cause of peripheral neuropathy it is one that should be evaluated before the patient is given the diagnosis of idiopathic neuropathy (we don’t know why you have neuropathy).  Just because you do not have the most common cause doesn’t mean you may not have a less common cause that would explain why you have symptoms and why they are progressing.  If the doctor can not find the cause of your symptoms, then it is difficult to stop your symptoms from getting worse, much less improve them.  Of course, there will always be patients who are idiopathic but lets try to make this category as small as possible by performing a thorough work up to eliminate as many known causes as possible.  Below are a couple of articles from the scientific literature supporting the association between Peripheral Neuropathy and Hypothyroidism.

1: Neurology. 2006 Sep 12;67(5):786-91.

Pain and small-fiber neuropathy in patients with hypothyroidism.

Orstavik K, Norheim I, Jorum E.

University of Oslo, Laboratory of Clinical Neurophysiology, Department of Neurology, Rikshospitalet University Hospital, Oslo, Norway. kristin.orstavik@medisin.uio.no

OBJECTIVE: To investigate large- and small-fiber function in patients with hypothyroidism and pain. METHODS: The authors studied 38 women treated for hypothyroidism and with painful extremities and 38 healthy controls. All subjects underwent neurologic examination of the extremities, neurophysiologic testing of large myelinated nerves, and thresholds for warmth detection (WDT), cold detection (CDT), heat-pain detection (HPDT), and cold-pain detection (CPDT) in one upper and both lower limbs. RESULTS: Eighteen patients had ongoing or intermittent ongoing distal pain in their limbs. Of these, 8 reported evoked and 10 reported paroxysmal pain. Fifteen patients had only diffuse musculoskeletal pain. A total of 16 patients had “hyperphenomena” (brush-evoked allodynia, punctate hyperalgesia, or cold allodynia or a combination of these, in their feet or hands or both). Eight patients were classified as having large fiber neuropathy, whereas 20 had “hypophenomena” (elevated thermal thresholds in their feet or hands or both). Thermal thresholds at the feet (WDT, CDT, and HPDT) were elevated (p = 0.001, p = 0.007, and p = 0.003, respectively) in the whole group of patients compared with the controls as well as WDT (p = 0.001) and CDT (p = 0.001) being elevated at the thenar eminence. All patients with ongoing, evoked, or paroxysmal pain had either hyperphenomena or hypophenomena or a combination of the two. CONCLUSIONS: Some patients treated for hypothyroidism have symptoms and findings compatible with small-fiber neuropathy or “hyperphenomena” indicating central sensitization.

1: Electromygr Clin Neurophysiol. 2007 Mar-Apr;47(2):67-78

Neuromuscular status of thyroid disease: a prospective clinical and electrodiagnostic study.

Somay G, Oflazoglu B, Us O, Surardamar A.

Marmara University, Institute of Neurological Sciences, Istanbul, Turkey. gsomay@hotmail.com

With this study, it has been intended to evaluate the neuromuscular symptoms and findings observed in patients with the diagnoses of hyperthyroidism and hypothyroidism. This study included 21 patients with hyperthyroidism, 19 patients with hypothyroidism and a control group comprised of 29 healthy persons. In the patient group with hypothyroidism, the increase in the median motor distal latency and the median sensorial distal latency (p < 0.0001), the reduction in the median sensory action potential amplitude (p < 0.01) and the slowing in the velocity of nerve conduction (p < 0.01) were found significantly different when compared to the control group. H-reflex latencies were determined to be significantly longer bilaterally (p < 0.01). In the patient group with hyperthyroidism, only the reduction in the median sensory action potential amplitude and the prolongation in the distal latency (p < 0.05) were significant. As for the lower extremities, the slowing in the velocity of the nerve conduction of bilateral peroneal (p < 0.0001), the prolongation in the peroneal F-wave latency (p < 0.01), the slowing in the velocity of the nerve conduction of bilateral tibial nerve (p < 0.05), the prolongation in the tibial F-wave latency (p < 0.01), the prolongation in the sural nerve distal latency (p < 0.0001) and the reduction in the sensory action potential amplitude (p < 0.05) were determined to be significantly different compared to the control group. Among the thyroid patients, 17 (42.5%) patients were diagnosed with mononeuropathy and polyneuropathy. Entrapment neuropathy was observed in 30% and diffuse neuropathy in 10% of the patients. Mypopathy findings were observed in 2 patients.

Dr. Mane is a board certified chiropractic orthopedist and neurologist.

For more information about the treatment of Peripheral Neuropathy or about Dr. Nelson Mane D.C. please visit our website at http://www.manecenter.com/neuropathy.htm. 

Dr. Mane offers one on one consultation as well as Group Seminars Peripheral Neuropathy Sufferers.  If you are interested in scheduling a consultation or to attend a seminar please call 813-935-4744. 

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