Advertisement

Hyperthyroidism in Moyamoya Disease

  • So-Hyang Im

Abstract

Hyperthyroidism is a clinical condition caused by the effects of excessive circulating thyroid hormones on various tissues of the body [1]. The various actions of thyroid hormone on many organ systems produce a broad spectrum of clinical signs and symptoms in patients with hyperthyroidism. An increased body's metabolism is characteristic in hyperthyroidism [2]. For this reason, patients often feel hotter than those around them and can slowly lose body weight even though they may be eating more food. When hyperthyroidism is severe, patients can suffer shortness of breath, chest pain, and muscle weakness [2]. Although there are several different causes of hyperthyroidism, most of the symptoms that patients experience are the same regardless of the cause [3]. Hyperthyroidism, thyroid storm, and Graves disease are conditions of excess thyroid hormone. Thyroid storm is a rare and potentially fatal complication of hyperthyroidism [4]. It typically occurs in patients with untreated or partially treated thyrotoxicosis who experience a precipitating event such as surgery, infection, or trauma [2]. Patients typically appear markedly hypermetabolic with high fevers, tachycardia, nausea and vomiting, tremulousness, agitation, and psychosis [5]. Graves disease (diffuse toxic goiter), the most common underlying cause of hyperthyroidism, is an autoimmune disease in which autoantibodies against the thyroid-stimulating hormone receptors inappropriately stimulate thyroid gland with ensuing excessive production and release of thyroid hormones [6]. The resultant hyperthyroid state produces multiorgan physiological derangements. Graves disease is associated with various autoimmune diseases such as pernicious anemia, vitiligo, type 1 diabetes mellitus, autoimmune adrenal insufficiency, systemic sclerosis, myasthenia gravis, Sjögren syndrome, rheumatoid arthritis, and systemic lupus erythematosus [7]. Utku et al. described reversible angiographical findings mimicking moyamoya disease at magnetic resonance (MR) angiography in a woman with a stroke-like episode and encephalopathy diagnosed as Graves disease [8]. In this case, her neurological status improved dramatically after methylprednisolone treatment and plasmapheresis, and the MR angiography abnormalities resolved after 3 months

Keywords

Systemic Lupus Erythematosus Thyroid Hormone Grave Disease Pernicious Anemia Moyamoya Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    McKeown NJ, Tews MC, Gossain VV et al (2005) Hyperthyroidism. Emerg Med Clin North Am 23:669–685PubMedCrossRefGoogle Scholar
  2. 2.
    Tietgens ST, Leinung MC (1995) Thyroid storm. Med Clin North Am 79:169–184PubMedGoogle Scholar
  3. 3.
    Ringel MD (2001) Management of hypothyroidism and hyperthyroidism in the intensive care unit. Crit Care Clin 17:59–74PubMedCrossRefGoogle Scholar
  4. 4.
    Waldstein SS, Slodki SJ, Kaganiec GL (1960) A clinical study of thyroid storm. Ann Intern Med 52:626–642Google Scholar
  5. 5.
    Fisher JN (2002) Management of thyrotoxicosis. South Med J 95:493–505PubMedGoogle Scholar
  6. 6.
    Weetman AP (2000) Graves' disease. N Engl J Med 343:1236–1248PubMedCrossRefGoogle Scholar
  7. 7.
    Cruz AA, Akaishi PM, Vargas MA et al (2007) Association between thyroid autoimmune dysfunction and non-thyroid autoimmune diseases. Ophthal Plast Reconstr Surg 23:104–108PubMedCrossRefGoogle Scholar
  8. 8.
    Utku U, Asil T, Celik Y et al (2004) Reversible MR angiographic findings in a patient with autoimmune Graves disease. Am J Neuroradiol 25:1541–1543PubMedGoogle Scholar
  9. 9.
    Kushima K, Satoh Y, Ban Y et al (1991) Graves' thyrotoxicosis and Moyamoya disease. Can J Neurol Sci 18:140–142PubMedGoogle Scholar
  10. 10.
    Liu JS, Juo SH, Chen WH et al (1994) A case of Graves' diseases associated with intracranial moy-amoya vessels and tubular stenosis of extracranial internal carotid arteries. J Formos Med Assoc 93:806–809PubMedGoogle Scholar
  11. 11.
    Tendler BE, Shoukri K, MalchoffC et al (1997) Concurrence of Graves' disease and dysplastic cerebral blood vessels of the moyamoya variety. Thyroid 7:625–629PubMedCrossRefGoogle Scholar
  12. 12.
    Wakamoto H, Ishiyama N, Miyazaki H et al (2000) The stenoses at the terminal portion of the internal carotid artery improved after initiation of antithyroid therapy: a case report. No Shinkei Geka 28:379–383 (Abstract)PubMedGoogle Scholar
  13. 13.
    Nakamura K, Yanaka K, Ihara S et al (2003) Multiple intracranial arterial stenoses around the circle of Willis in association with Graves' disease: report of two cases. Neurosurgery 53:1210–1215PubMedCrossRefGoogle Scholar
  14. 14.
    Kim J Y, Kim BS, Kang JH (2001) Dilated cardiomyopathy in thyrotoxicosis and Moyamoya disease. Int J Cardiol 80:101–103PubMedCrossRefGoogle Scholar
  15. 15.
    Matsumoto K, Nogaki H, Yamamoto K et al (1992) A case of moyamoya disease complicated with Basedow disease. Jpn J Stroke 14:409–413CrossRefGoogle Scholar
  16. 16.
    Garcin B, Louissaint T, Hosseini H et al (2008) Reversible chorea in association with Graves' disease and moyamoya syndrome. Mov Disord 23:620–622PubMedCrossRefGoogle Scholar
  17. 17.
    Ni J, Gao S, Cui LY et al (2006) Intracranial arterial occlusive lesion in patients with Graves' disease. Chin Med Sci J 21:140–144PubMedGoogle Scholar
  18. 18.
    Sasaki T, Nogawa S, Amano T (2006) Co-morbidity of moyamoya disease with Graves' disease. report of three cases and a review of the literature. Intern Med 45:649–653Google Scholar
  19. 19.
    Hsu SW, Chaloupka JC, Fattal D (2006) Rapidly progressive fatal bihemispheric infarction secondary to moyamoya syndrome in association with Graves thyrotoxicosis. Am J Neuroradiol 27:643–647PubMedGoogle Scholar
  20. 20.
    Golomb MR, Biller J, Smith JL et al (2005) A 10-year-old girl with coexistent moyamoya disease and Graves' disease. J Child Neurol 20:620–624PubMedCrossRefGoogle Scholar
  21. 21.
    Im SH, Oh CW, Kwon OK et al (2005) Moyamoya disease associated with Graves disease: special considerations regarding clinical significance and management. J Neurosurg 102:1013–1017PubMedCrossRefGoogle Scholar
  22. 22.
    Shen AL, Ryu SJ, Lin SK (2006) Concurrent moyamoya disease and Graves' thyrotoxicosis: case report and literature review. Acta Neurol Taiwan 15:114–119PubMedCrossRefGoogle Scholar
  23. 23.
    Garcin B, Louissaint T, Hosseini H et al (2008) Reversible chorea in association with Graves' disease and moyamoya syndrome. Mov Disord 23:620–622PubMedCrossRefGoogle Scholar
  24. 24.
    Squizzato A, Gerdes VE, Brandjes DP et al (2005) Thyroid diseases and cerebrovascular disease. Stroke 36:2302–2310PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  1. 1.Department of NeurosurgeryThomas Jefferson University HospitalPhiladelphiaUSA

Personalised recommendations