Painful neuropathy in subclinical hypothyroidism: clinical and neuropathological recovery after hormone replacement therapy.
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 Conversely, symptomatic treatments for neuropathic pain were withdrawn after few days because of side effects.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.
Penza
Paola
P
Neuromuscular Diseases Unit, National Neurological Institute Carlo Besta, via Celoria, 11, 20133, Milan, Italy. paola.penza@istituto-besta.it
Lombardi
Raffaella
R
Camozzi
Francesca
F
Ciano
Claudia
C
Lauria
Giuseppe
G
D001706:Biopsy; D004967:Estrogens / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D005528:Foot / Q000294:innervation / Q000503:physiopathology; D020249:Hormone Replacement Therapy; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D009416:Nerve Regeneration / Q000187:drug effects / Q000502:physiology; D009431:Neural Conduction / Q000187:drug effects / Q000502:physiology; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D010147:Pain Measurement; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D011984:Sensory Receptor Cells / Q000187:drug effects / Q000473:pathology / Q000502:physiology; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D016896:Treatment Outcome
D004967:Estrogens