Uses of Antithyroid Antibodies in Nonvascular Hemisensory Impairment

Abstract

To find out the uses and correlation of antithyroid antibodies in patients with hemisensory impairment. Background: In
day-to-day clinical practice, we have difficulties in managing patients with hemisensory impairment, where the diagnostic
tests are not supporting clinical localization. Material and methods: All patients, aged 18 years and above, who came to the
Neurology Department between February 2018 and August 2019 with either right or left persistent hemisensory impairment
with or without facial involvement, were included. After the clinical assessment, appropriate investigations (complete blood
counts, urea, creatinine, electrolytes, thyroid-stimulating hormone [TSH], serum B12, antinuclear antibodies [ANA] profile,
perinuclear antineutrophil cytoplasmic antibodies [pANCA], cytoplasmic antineutrophil cytoplasmic antibodies [cANCA],
neurolaboratory tests, carotid vertebral arterial Doppler study, magnetic resonance imaging [MRI] brain with magnetic
resonance angiogram [MRA]/MRI brain with contrast) were done to confirm the diagnosis or to treat accordingly. Patients
with acute stroke, demyelination, hemiplegic migraine and transient ischemic attack (TIA) were excluded. Rest of them were
advised to undergo serum antithyroid antibodies and psychiatric assessment. Patients with positive antithyroid antibodies
were treated with prednisolone 1 mg/kg/day for 6 weeks and reviewed. Psychiatric follow-up was done in patients with
negative antithyroid antibody reports. Uses and correlation of antithyroid antibodies were analyzed. Results: A total
of 33 patients were studied. Among them, 28 (85%) were females, 5 (15%) males and the mean age of presentation was
41.6 years. Out of 33 patients, 27 (82%) had subjective feeling of subacute onset persistent tingling sensation or numbness
or tightness or hypo-/hyperesthesia or uneasiness on either side of the body with or without face involvement. Rest of the
6 patients (18%), had numbness with feeling weak on one side with no demonstrable sensory motor deficit. Antithyroid
antibodies (antithyroglobulin and antithyroid peroxidase antibodies) were positive in 21 (64%) patients with hemisensory
impairment. In this study, 28 (85%) were in euthyroid, 3 patients (9%) in hypothyroid and 2 (6%) were in hyperthyroid
groups. Antithyroid antibodies were positive in 61%, 66% and 100%, respectively in the thyroid groups. None of our study
patient had psychiatric illness or brain lesions on MRI study. Conclusion: Autoimmune thyroiditis can present with new
onset persistent hemisensory impairment in young adults, which is more common in females. Both antithyroid antibodies
are clinically useful in the diagnosis and management of nonvascular hemisensory impairment. Hence, the strong clinical
judgment not supported by the diagnostic tests might alert the physician to rule out autoimmune thyroiditis in neuroaxis.