J Clin Neurol.  2011 Sep;7(3):168-172. 10.3988/jcn.2011.7.3.168.

Concurrence of Multifocal Motor Neuropathy and Hashimoto's Thyroiditis

• Ahn SW
• Kim SH
• Park BS
• Cha JI
• Kim SM
• Sung JJ
• Lee KW

• KMID: 2287634
• DOI: http://doi.org/10.3988/jcn.2011.7.3.168

Abstract

BACKGROUND
Multifocal motor neuropathy (MMN) is an immune-mediated disorder that is characterized by slowly progressive and asymmetrical weakness, but its pathophysiological mechanism is uncertain. The hypothesis that MMN is an immunological disease has been supported by the proven therapeutic effects of intravenous immunoglobulin and the detection of antiganglioside antibodies in MMN patients. The coexistence of MMN with other immune diseases has been rarely reported.
CASE REPORT
A 37-year-old woman visited our hospital complaining of weakness in both hands. The clinical manifestations coincided well with MMN: predominantly distal upper-limb weakness, asymmetric involvement, a progressive course, absence of sensory symptoms, absence of pyramidal signs, and sparing of the cranial muscles. The electrophysiological findings also supported a diagnosis of MMN, with motor nerve conduction block in the median, ulnar, and radial nerves, without sensory nerve involvement. The patient was simultaneously diagnosed as having Hashimoto's thyroiditis, which is a well-known immune-mediated disease.
CONCLUSIONS
The concurrence of MMN and Hashimoto's thyroiditis in our patient is significant for understanding the immunological characteristics of the two diseases.

Keyword

multifocal motor neuropathy; hashimoto's thyroiditis; MMN

MeSH Terms

Adult
Antibodies
Female
Hand
Humans
Immune System Diseases
Immunoglobulins
Muscles
Neural Conduction
Radial Nerve
Thyroid Gland
Thyroiditis
Antibodies
Immunoglobulins

Figure

• 

  Fig. 1 Deformities of both hands in our patient. Severe deformities in the right hand (A) were much improved (B) after treatment with high-dose intravenous immunoglobulin (0.4 g/kg/day) for 5 consecutive days.

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  Fig. 2 Raw data of nerve conduction studies (NCSs) of the patient's right median motor nerve (A), left median motor nerve (B), right ulnar motor nerve (C), left ulnar motor nerve (D), right radial motor nerve (E), and left radial motor nerve (F). The raw data shown on the left and right sides of the arrow correspond to before and after treatment, respectively. Before intravenous immunoglobulin therapy, the NCSs revealed conduction block in right median motor nerve, left median motor nerve, right ulnar motor nerve, left ulnar motor nerve and left radial nerve. One month later, after high-dose intravenous immunoglobulin therapy, conduction blocks were improved, especially for the left median motor nerve, right ulnar motor nerve, and left radial motor nerve. F-W: finger-wrist, W-E: wrist-elbow, E-Ax: elbow-axilla, W-B.E: wrist-below elbow, B.E-A.E: below elbow-above elbow, A.E-Ax: above elbow-axilla.

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  Fig. 3 Microscopy findings of a biopsy sample of the patient's thyroid tissue reveal diffuse lymphocyte infiltration (black arrows) and a few sheets of follicular epithelial cells (white arrows) without malignant cells (Papanicolaou staining: A, ×200; B, ×400).

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