Kumazawa K, Sobue G, Okamoto H, Yuasa K, Mitsuma T
Fourth Department of Internal Medicine, Aichi Medical University.
Rinsho Shinkeigaku. 1991 Jul;31(7):768-71.
We have reported two cases of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with Graves' disease. Case 1: a 45-year-old woman noticed a diffuse goiter, palpitation and emaciation in 1977. Laboratory studies confirmed that she had Graves' disease, and she was treated with antithyroid drug. In 1986, when the hyperthyroidism was subsided, she showed progressive symmetrical weakness and numbness in her limbs, and she was almost in tetraplegia at 1987. Markedly slowed motor and sensory nerve conductions and elevated CSF proteins as well as clinical manifestations confirmed the diagnosis of CIDP. Following corticosteroid-pulse therapy and plasmapheresis resulted in good recovery in both motor and sensory impairment, though two-times of relapses were observed. Case 2: a 33-year-old man first noticed weakness in his legs in 1977, motor and sensory disturbances progressed for 12 years. Slowed nerve conduction, high CSF proteins and two-times of relapses in early phase indicated that the CIDP was the diagnosis. In 1989 he complained general fatigue, hyperhidrosis and body-weight loss. The serum thyroid hormone levels were high, and other laboratory studies confirmed the presence of Graves' disease. The cases with both CIDP and Graves' disease has rarely been reported. The background mechanism of this association is not well understood, but the susceptibility to CIDP and Graves' disease may be related to the HLA antigens and immunoglobulin Gm allotypes of which are the genes linked to the major histocompatibility complex and controlling immune responses. The present two cases commonly shared several HLA-DR antigens, but their significance should be confirmed by examining many cases.
我们报告了两例与格雷夫斯病相关的慢性炎症性脱髓鞘性多发性神经根神经病（CIDP）。病例1：一名45岁女性在1977年发现弥漫性甲状腺肿、心悸和消瘦。实验室检查证实她患有格雷夫斯病，并用抗甲状腺药物进行了治疗。1986年，当甲状腺功能亢进消退时，她出现了四肢进行性对称性无力和麻木，到1987年几乎四肢瘫痪。运动和感觉神经传导明显减慢、脑脊液蛋白升高以及临床表现证实了CIDP的诊断。皮质类固醇冲击疗法和血浆置换后，运动和感觉障碍均有良好恢复，不过观察到两次复发。病例2：一名33岁男性于1977年首次注意到腿部无力，运动和感觉障碍持续了12年。神经传导减慢、脑脊液蛋白升高以及早期两次复发提示诊断为CIDP。1989年，他主诉全身乏力、多汗和体重减轻。血清甲状腺激素水平升高，其他实验室检查证实存在格雷夫斯病。CIDP和格雷夫斯病并存的病例鲜有报道。这种关联的背景机制尚不清楚，但对CIDP和格雷夫斯病的易感性可能与HLA抗原和免疫球蛋白Gm同种异型有关，它们是与主要组织相容性复合体相关并控制免疫反应的基因。目前这两个病例共同具有几种HLA - DR抗原，但其意义应通过检查更多病例来证实。
