title: Chronic severe axonal polyneuropathy associated with hyperthyroidism and multivitamin deficiency.
abstract: OBJECTIVE
  Hyperthyroidism is often associated with various neuromuscular disorders, most commonly proximal myopathy. Peripheral nerve involvement in hyperthyroidism is very uncommon and has rarely been reported. We describe a 29-year-old woman with untreated hyperthyroidism who presented with chronic severe axonal sensory-motor polyneuropathy. Peripheral nerve involvement developed together with other symptoms of hyperthyroidism 2 years before presentation. She also had anorexia nervosa for the past 6 months, resulting in multivitamin deficiency.
  
  
  RESULTS
  Electrophysiological and pathological findings as well as clinical manifestations confirmed the diagnosis of severe axonal polyneuropathy. Anorexia nervosa has been considered a manifestation of untreated hyperthyroidism. We considered hyperthyroidism to be an important causal factor in the polyneuropathy in our patient, although peripheral nerve involvement in hyperthyroidism is rare. To our knowledge, this is the first documented case of chronic severe axonal polyneuropathy ascribed to both hyperthyroidism and multivitamin deficiency.
  
  
  CONCLUSIONS
  Our findings strongly suggest that not only multivitamin deficiency, but also hyperthyroidism can cause axonal polyneuropathy, thus expanding the clinical spectrum of hyperthyroidism.
authors: Department of Neurology, Nara Medical University School of Medicine, Kashihara, Nara, Japan. ksugie@naramed-u.ac.jp
authors: Kazuma
authors: K
authors: Sugie
authors: Fujio
authors: F
authors: Umehara
authors: Hiroshi
authors: H
authors: Kataoka
authors: Aya
authors: A
authors: Kumazawa
authors: Satoshi
authors: S
authors: Ueno
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications / Q000503:physiopathology; D001361:Avitaminosis / Q000150:complications* / Q000503:physiopathology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000503:physiopathology*; D008854:Microscopy, Electron; D009046:Motor Neurons / Q000502:physiology / Q000648:ultrastructure; D011115:Polyneuropathies / Q000209:etiology* / Q000503:physiopathology*; D011984:Sensory Receptor Cells / Q000502:physiology / Q000648:ultrastructure; D012720:Severity of Illness Index; D013497:Sural Nerve / Q000502:physiology / Q000648:ultrastructure