甲状腺毒症背景下的多神经病变与噻马唑药物治疗

V. I. Oblaukhova, D. Svetlana, S. Mustafina
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摘要

本文报道一例43岁的明显甲状腺毒症患者,临床表现为上肢和下肢肌肉剧烈疼痛,每日服用噻马唑25mg后发展为中毒性多神经病变的临床病例;上肢肌肉无力。在神经科医生的处方下,患者接受卡马西平缓缓剂400 mg /天的治疗,持续1个月,主治医生决定用丙硫尿嘧啶300 mg /天替代替马唑,随后调整剂量。病人断然拒绝手术治疗或放射性碘治疗。在与关节和肌肉炎症性疾病鉴别诊断时,确认了中毒性多神经病的诊断,甲状腺毒中毒背景下的多神经病。在治疗的结果中,所有神经症状都停止了。多神经病变时的观察时间为1个月,发表时患者的总观察时间为5年。本临床病例表明,在接受硫马唑治疗甲状腺毒症的患者中,可能发生中毒性多神经病变。鉴于这种并发症在临床实践中的低频率,有必要引起临床医生对这种情况的额外关注,并建议将这种情况纳入多发性神经病变的鉴别诊断。
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Polyneuropathy on the background of thyrotoxicosis with thiamazole drug treatment
The article is devoted to the clinical case of the development of toxic polyneuropathy in patients receiving thiamazole 25 mg per day in a 43-year-old patient with manifest thyrotoxicosis, which is clinically manifested by severe pain in the muscles of the upper and lower extremities; muscle weakness in the upper limbs. The patient, prescribed by a neurologist, was treated with carbamazepine-retard 400 mg per day for 1 month, and the attending physician decided to replace tiamazole with propylthiouracil 300 mg per day, followed by dose adjustment. The patient categorically refuses surgical treatment or treatment with radioactive iodine. The diagnosis of toxic polyneuropathy was confirmed during the differential diagnosis with inflammatory diseases of the joints and muscles, polyneuropathy on the background of thyrotoxicosis. In the outcome of the treatment, all neurological symptoms were stopped. The observation time on the occasion of polyneuropathy was 1 month, the total time of observation of the patient at the time of publication was 5 years. This clinical case demonstrates the possibility of the development of toxic polyneuropathy in patients receiving thiamazole in the treatment of thyrotoxicosis. Given the low frequency of this complication in clinical practice, it is necessary to draw additional attention of clinicians to this case and recommend including this condition in the differential diagnosis of polyneuropathy.
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