NEUROLOGICAL MANIFESTATIONS IN THE THYROID PATHOLOGY - SNPCAR

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Manifestations in patients with various thyroid disorders we had the following objectives: The evaluation of the frequency of neurological manifestations in thyroid disorders.

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The identification of some specific clinical pictures in various thyroid disorders. Revealing the difficulties of diagnosis regarding the nervous system disorders produced by thyroid pathologies. The study was conducted over a period of 5 years. Clinical and laboratory characteristics of the study group regarding terms of neurology and endocrinology.

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Patients from the study group were examined clinically and paraclinically every 3 months. Out of all the examined cases with thyroid pathology, cases had presented neurological symptoms. The prevalence of neurological manifestations in patients with thyroid pathologies was of Methods The research followed the recommended methodology for realizing the clinical and epidemiological studies.

NEUROLOGICAL MANIFESTATIONS IN THE THYROID PATHOLOGY

Choosing the subjects The patients that were included in the study group were recruited among the hospitalized patients with thyroid disorders that were admitted in the neurology and endocrinology wards of the Emergency Hospital Galati or that were present in the sections of neurology and endocrinology from the Specialized Clinic of the hospital.

Clinical examination was correlated with laboratory tests. Laboratory data recommended, most of the time pursued and partially performed was recorded in the observations charts of the departments and offices mentioned.

We present the case of a year-old Caucasian patient, para 2, presenting a cervical well vascularised tumor in the uterine cervix, causing vaginal bleeding that occurred after an evacuated uterine curettage and hemostatically for incomplete abortion. The diagnosis of suspected cervical pregnancy was established based on the imaging aspect: the transvaginal ultrasound showed a parenchymal mass protruding into the cervical canal with intense peripheral vascular network. The histopathological results correlated with elevated levels of β-hCG suggested the diagnosis of choriocarcinoma.

Data gathering Laboratory data was collected from the observation charts of the above mentioned Sections and also from the sheets of neurological and endocrinological medical supervision. The clinical trial was conducted with the consent of the investigated patients and had the approval of the Bioethics Commission of the Emergency Hospital Galati.

For the clinical diagnosis of hyperthyroidism we used the Newcastle index.

Deficitul de estrogeni postpubertar se caracterizeaz prin conservarea morfotipului feminin normal, dar: involuia de intensitate variabil a caracterelor sexuale primare organe genitale i secundare, diminuarea libidoului i disfuncie sexual, deficit energetic, tulburri de ciclu menstrual bradi- oligo- i hipomenoree sau amenoree secundar anovulaie cronic i infertilitate, tulburri psihice i vegetative: bufeuri de cldur, transpiraii, valori tensionale oscilante. Explorri paraclinice i de laborator Se vor efectua: testul Barr; cariotip; E2 este sczut; gonadotropinele crescute; ecografia ovarian i uterin poate aduce informaii suplimentare i este obligatorie n disgeneziile ovariene. Dei nu se mai indic n mod curent, laparotomia exploratorie cu examenul histo-patologic al ovarului poate fi necesar.

In the clinical evaluation of hypothyroidism we followed the Billewicz index. For the endocrinological laboratory diagnosis there were used: hormone dosages: T3, T4, FT4, TSH, prolactin, corthysol, human papillomavirus rash description basal metabolism; thyroid ultrasound, thyroid scintigraphy — substance used being 99 mTcO4, in dosages of 2 mCi; fine needle thyroid puncture biopsy — ABC; sella turcica radiography, brainCT, brain Uterine cancer brain metastases, biochemical usual dosages in blood and urine: cholesterol, Hb, Ht, number of white cells with leukocyte formula, liver tests, CPK, TGO, TGP, total proteins, bilirubin, alkaline phosphatase; immunoassay: immunoelectrophoresis, lupus cells, C-reactive protein, serum complement, circulating immune complexes, lues tests, antithyroglobulin antibodies, antiperoxidase antibodies; bone scintigraphy, EKG.

For studying the neurological damage, there were used: electromyography data, VCM, VCS, oculus fundus examination; EEG including mapping and spectral map; Brain uterine cancer brain metastases mediastinum CT, using contrast substances iopamiro and omnipaque; brain MRI — using the same device previously described, using gadolinium as well; uterine cancer brain metastases biopsy with uterine cancer brain metastases microscopy evaluation; muscle biopsy with optical microscopy evaluation; pathological examination of neurosurgical excision parts ; pulmonary, mediastinal, bone X-ray; Doppler- ECD, TCD; CSF study; biochemical blood and urine usual dosages, mentioned above; bone scintigraphy with same equipment mentioned before; 3.

Processing and statistical data analysis The processing and data analysis were conducted using a suitable software.

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We calculated central tendency indicators mean and standard deviationstructure indicators and frequency indicators prevalence. Main morbid associations in patients from the study group included: — Diabetes type I and II; — Primary hypertension; — Dyslipidemia; — Various forms of neoplastic cancer or benign tumors: uterine cancer; uterine fibroids; generalized lymphomas uterine cancer brain metastases thyroid localization; brain tumors: meningioma; uterine cancer brain metastases prostate adenoma; lipomas; — Heart rhythm disorders: paroxysmal and chronic atrial fibrillation, atrial and ventricular extrasystolic arrhythmias and cardiac conduction disorders; — Strokes: constituting ischemic stroke, transient stroke uterine cancer brain metastases haemorrhagic accidents; — Profound thrombophlebitis of the lower limbs; uterine cancer brain metastases Hypocalcemic tetany, hypomagnesemic tetany; 5.

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Also, neurological suffering led to, in many cases, the diagnosis of the causing thyroid pathology. In most cases, neurological manifestations were installed progressively, fact confirmed by other studies [2].

The high frequency of clinical neurological manifestations in the study group both in the moment of admission as well as during their evolution imposed further research to establish their etiology.

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The study highlights the clinical uterine cancer brain metastases epidemiological aspects regarding the neurological manifestations in thyroid diseases with the simptome limbrici la adulti conclusions: Neurological manifestations generally occurred progressively in the majority of the cases, rarely acute; Neurological damage occurred lately in the patients known with thyroid disorders but in a greater number of cases the neurological affection was revealing for detecting the primary thyroid condition; Remission of neurological signs and symptoms under the basic treatment of thyroid disorders was generally obvious; A definite conclusion of the study is that very often patients with different types of thyroid disorders present themselves initially in the neurology ward due to the fact that the thyroid symptoms can often be confused with a neurological disease, fact citated in other studies [5].

In hyperthyroidism we encountered central nervous system manifestations, muscular manifestations, and peripheral nerve system manifestations: Central nervous system manifestations included psychiatric disorders, headaches and training vertiginous syndromes, loss of consciousness, strokes, seizures, suffering of the central nervous system through thyrotoxicosis crisis.

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Psychiatric manifestations are extremely common in these cases from mild to severe such as schizophrenia, paranoia uterine cancer brain metastases. Patients are often wrongly labeled and initially treated in psychiatric wards for mental diseases when in reality the symptoms are caused by thyrotoxicosis.

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Headache and vertigo were often encountered, sometimes requiring, because of their resistance to treatment, a brain CT. Syncope and fainting episodes were also frequent in patients with hyperthyroidism, being a reason for which a large number of patients presented themselves in the neurology service.

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Ischemic stroke was less common in patients with hyperthyroidism and more common in those with hypothyroidism from the study group, in the cases of thyrotoxicosis this occurred in patients with heart rhythm disorders caused by dysthyroidism who also presented other risk factors. Seizures associated with hyperthyroidism, although probably with no endocrinopathy causal relationship were reduced after associating anticonvulsant therapy with antithyroid synthesis treatment.

Thyrotoxicosis crisis imposes an urgent differential diagnosis through confessional syndrome, psychomotor agitation, generalized convulsive seizures, fever, signs and symptoms of neurological or infectious type that require the neurologist to proceed with an urgent differential diagnosis.

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Muscular manifestations occurred in patients with old hyperthyroidism which was generally therapeutically neglected.

These included common accuses such as muscle weakness, muscle cramps, myalgia which were reduced by treatment with antithyroid synthesis drugs.

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Regarding the thyrotoxic myopathy, in the study group we have encountered only chronic thyrotoxic myopathies, although in other studies there are frequently cited cases of acute thyrotoxic myopathies. Chronic thyrotoxic myopathy occurred exclusively in women, other studies indicating that it occurs mainly in men with hyperthyroidism.

Chronic muscular affection particularly affected the pelvic muscles, uterine cancer brain metastases enzymes were within normal limits CPK and the muscle biopsy was nonspecific.

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