Ultrasonography of median nerve in carpal tunnel syndrome before and after hormone replacement in patients with hypothyroidism

Abstract

Background: We evaluated the efficacy of ultrasound in newly diagnosed hypothyroidpatients suffering manifestations of median nerve entrapment before and afterhormone replacement therapy. Patients and methods: Forty patients with a mean age of 47.8±12 yearsdiagnosed with hypothyroidism were included in this study. Electrodiagnosticworkup and Ultrasonographic assessment for both right and left median nerves atthe initial time of diagnosis and 3 months of euthyroid state after hormonereplacement. Results: Thyroidhormones at the initial time of diagnosis were (48.38±30 IU/Ml,7.59±2.98 pmol/l. 1.79±0.81Pmol/l) and 3 months of euthyroid state aftertreatment were (6.33±4.75IU/Ml, 15.52±4.86 pmol/l, 4.06±0.62 Pmol/l) for TSH,FT4, FT3 respectively (P =0.001). The comparison between right and left mediannerves motor and sensory functions before and after treatment showed asignificant change (P < 0.001). Initial values of right median nerve distaland proximal CSA were 12.5±2.4 mm2 and 9.6±0.5 mm2respectively while on the left side values were 12.4±2.4 mm2 and9.9±0.5 mm2 respectively. After treatment, values changed to12.0±2.4 mm2 (distal) and 0.096±.004 mm2 (proximal) onthe right side and 12.0±2.3 mm2 (distal) and 9.8±.0.5 mm2(proximal) on the left side. 25 patients (62.5 %) showed significantelectrophysiological and radiological improvement with hormonal control. Whilefifteen patients (37.5%) were still suffering manifestaions of carpal tunnelsyndrome even after hormonal control.Conclusion: The median nerve cross sectional area can be used as a guide forselection of patients that may benefit from a surgical release even beforecommencement of medical treatment.