[meb]

#1073691

Hi, I have no idea what your son’s symptoms are, so I’m sure your doctor is a much better resource for info, but I have Graves and I just got what very much appears to be classic carpal tunnel syndrome as well as ulnar tunnel syndrome in both of my hands. I type heavily on a laptop and use a mouse, which is undoubtedly contributing to my problem. But if your son is having pain at night in particular (which I don’t know), and you haven’t already considered carpal tunnel, consider giving it a moment’s thought. Carpal tunnel can typically be alleviated with the use of splints at night, which keeps one from curling fetal in a manner that stresses the wrists. Before I developed it last week, I had no idea it was caused in part by night-time wrist positions.

I’m only starting to investigate my own problem, but in case this info is any use to you or others, here are some articles that touch on a possible connection between Graves and carpal tunnel syndrome:

Author
Arikan, Ender MD *; Pekindil, Gokhan MD ++; Guldiken, Sibel MD *; Pekindil, Yesim MD +
Institution
From the *Endocrinology Department, +Physical Therapy and Rehabilitation Department, and ++Radiology Department, Trakya University, Medical Faculty, Edirne, Turkey.
Title
The Evaluation of the Median Nerve in Subclinical Hypothyroidism by High-Resolution Sonography.[Miscellaneous]
Source
Endocrinologist. 15(4):209-212, July/August 2005.
Abstract
The aim of this study is to evaluate whether subclinical hypothyroidism causes any alteration of the median nerve diameters by using sonography, and whether l-thyroxine treatment can improve the median nerve dimensions. Twenty-two female patients with subclinical hypothyroidism participated in this study. All patients were asked for the manifestations of carpal tunnel syndrome. They were examined and nerve conduction tests were performed. Right and left median nerve measurements (major and minor axis and cross-sectional area) were determined in all patients by high-resolution sonography before and after euthyroidism was achieved with l-thyroxine treatment. All sonographic measurements were within normal limits in 18 of 22 cases. Four patients had increased the measurements of the median nerve, but only 2 cases of 4 had increased cross-sectional area of median nerve and one of them had clinical symptoms simulating carpal tunnel syndrome. None of them has positive clinical s!
igns of carpal tunnel syndrome. Nerve conduction velocities did not indicate carpal tunnel syndrome in patients with subclinical hypothyroidism. l-thyroxine treatment significantly decreased the mean cross-sectional area, minor and major axes of the right and left median nerves. Clinical symptoms were gradually improved. There was no correlation between the measurement of median nerve and thyroid hormones, thyroid-stimulating hormone, body mass index, and age. The duration of treatment with l-T4 and dose did not correlate with the measurement of the median nerve. This study shows that subclinical hypothyroidism causes some alterations in the median nerve diameters in a few patients. l-Thyroxine replacement in subclinical hypothyroidism decreases the measurements of the median nerve.

Author
Suresh, Ernest MD, MRCP; Morris, Ian M. FRCP
Institution
From the *Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Scotland; and the +Department of Rheumatology, Kettering General Hospital, Kettering, United Kingdom.
Title
How Valuable Is Screening for Thyroid Disease in Patients With Carpal Tunnel Syndrome?[Article]
Source
JCR: Journal of Clinical Rheumatology. 10(3):116-118, June 2004.
Abstract
Background: It has been suggested that many patients with carpal tunnel syndrome have associated thyroid or other metabolic diseases.

Methods: 206 patients with clinical features suggestive of carpal tunnel syndrome (CTS), including those with known underlying cause of CTS, were screened for thyroid dysfunction. Nerve conduction studies were compatible with a diagnosis of CTS in 136 patients (CTS group).

Results: We diagnosed only 2 new cases of hypothyroidism (1.5% of patients in the CTS group) and none with hyperthyroidism.

Conclusions: Thus routine screening of patients with isolated CTS for thyroid function abnormality does not appear to be worthwhile.

Author
Atcheson, Steven G. MD; Ward, John R. MD; Lowe, Wing PhD
Institution
From the Arthritis Specialists of Northern Nevada, Reno (Dr Atcheson); University of Utah School of Medicine, Salt Lake City (Dr Ward); and Center for Biomedical Modeling Research, University of Nevada School of Medicine, Reno (Dr Lowe).
Title
Concurrent Medical Disease in Work-Related Carpal Tunnel Syndrome.[Article]
Source
Archives of Internal Medicine. 158(14):1506-1512, July 27, 1998.
Abstract
Background: Work-related carpal tunnel syndrome (CTS) now accounts for more than 41% of all repetitive motion disorders in the United States. Carpal tunnel syndrome is also associated with obesity and many different medical diseases.

Patients and Methods: Two hundred ninety-seven patients medically certified with a work-related upper extremity industrial illness underwent a systematic search for concurrent medical diseases. Diagnoses of CTS were made using 4 separate case definitions.

Results: One hundred nine separate atraumatic illnesses (mainly hypothyroidism, diabetes mellitus, and various arthropathies) capable of causing arm pain or CTS were diagnosed in a third of all patients. Using record reviews and patient histories alone, 68% of these conditions would have been missed. One hundred ninety-eight patients had been diagnosed as having CTS 420 times in more than 1000 office visits, but diagnostic laboratory studies were ordered only 25 times. Every case definition of CTS was significantly associated with a related medical condition. Two definitions yielded more than 41% prevalence of concurrent disease (odds ratio, >or= to 2.36; P <or= to.004), and up to two thirds of these patients had either a medical disease or were obese (odds ratio, >or= to 3.15; P <or= to.001). Two cohorts totaling 114 patients (38%) working for companies employing nearly 19 000 people included all CTS claims filed during 2 evaluation periods. They did not differ from the o!
ther patients with CTS with respect to age, concurrent disease, or obesity.

Conclusions: Routine patient histories and record reviews are inadequate for proper evaluation of work-related CTS. Unrecognized medical diseases capable of causing CTS are common. Studies asserting an association between occupational hand usage and CTS are of questionable validity unless they prospectively account for confounding disease and obesity.

Arch Intern Med.1998;158:1506-1512

Copyright 1998 by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. American Medical Association, 515 N. State St, Chicago, IL 60610.

Author
El-Salem, Khalid *; Ammari, Fawaz +
Institution
*Clinical Neurophysiology and +Internal Medicine-Endocrinology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan.
Title
Neurophysiological Changes in Neurologically Asymptomatic Hypothyroid Patients: A Prospective Cohort Study.[Article]
Source
Journal of Clinical Neurophysiology. 23(6):568-572, December 2006.
Abstract
Summary: This is a prospective cohort study on neurologically asymptomatic patients with primary hypothyroidism. It was conducted to evaluate the frequency and pattern of neurophysiological changes in this group of patients. Twenty-three subjects were included over a period of 21/2 years. Neurophysiological evaluation included nerve conduction studies (NCS) of median, ulnar, and peroneal motor nerves as well as median palmar and ulnar and sural sensory responses. Electromyography of deltoid, first dorsal interosseous, vastus lateralis, and tibialis anterior muscles was performed with concentric needle electrodes in which duration, amplitude, and stability of motor unit action potentials, recruitment, and interference pattern were evaluated. NCS showed that 52% of the patients had some abnormality, predominantly of the motor demyelinating pattern, as evidenced by prolonged F-wave and distal latencies with normal amplitudes in most affected nerves. Thirty percent of patients!
had median mononeuropathy consistent with carpal tunnel syndrome. Nondisfigurative myopathic changes in the form of myopathic motor unit action potentials without spontaneous activity were seen in 74% of the patients, most commonly in deltoid (70%). Frequencies of involvement of other muscles were 39% in the vastus lateralis muscle, 26% in tibialis anterior muscle, and 9% in the first dorsal interosseous muscle. We conclude that electromyographic/NCS changes commonly exist in treated, neurologically asymptomatic patients with hypothyroidism and are most frequently myopathic. Median neuropathy is the most common nerve abnormality. Other nerves are involved, with a higher tendency for motor nerve demyelination. We speculate that some neuromuscular changes secondary to hypothyroidism persist after treatment and that motor nerve abnormalities are less likely to be symptomatic than sensory nerve changes in these patients.

[mamabear]

#1019722

Last year I posted about my ds13 who has had painful hands since 2007. Here is the link

He has been to a Rheumatologist that I thought was a pediatric dr. but he wound up being a dr. who saw kids. NOT the same. So today he went to a Pediatric Rheum who ordered a bunch of tests on him including Thyroid for Hashi’s and a bunch of stuff for Thyroid, Sed Rate and a few for antibodies as well. As well as for Crohn’s and celiac disease and well lets just say it was 10 vials worth and son was so not thrilled.
Hopefully we will have results by the end of the week.

Dr. was concerned because my mother has Hypo now at age 54(diagnosed at 53) and her brothers have (oldest Hashi’s) and youngest graves disease. and mom has crohn’s disease now diagnosed 08′.

Dr. was looking at Hashi’s and that might causing his arthritis and was concerned about his slightly high T4 I think it was 505 and the range was up to 480. Not that much higher but she seemed concerned and I’m not sure why.

She also thought that Psoriasis might be the cause as well even though he has no visible psoriasis but because I mentioned that twice in his life he had what I thought was seborrhea dermatitis and it was same spot and got worse with the 2nd time she felt it was psoriasis but couldn’t be sure so testing for lots of stuff.

I know this isn’t Graves related but wanted to keep a record for myself of this and this is where I first posted it. He is still in so much pain and using his hands hurts him to a point where he has to stop. This poor kid wanted to do track and the Dr. stupidly said yes go ahead I wont stop you BUT you need to strengthen your joints and track starts in 4 weeks and she wants him to do PT for 3months. There is no way he will be strong enough and he is mad.
Naturally I wont back down on what I am firm on and that is no track period and I dont care what any dr. says he can or can’t do.

I don’t know enough about Hashi’s to think it has something to do with his arthritis? I don’t get it. I know graves disease but hypo as well? Am I just loosing my mind in not remembering that hypo does this…. (brain fog I swear!!!).

[meb]

#1073692

Hi, My earlier post to you may not have been useful, but thought I’d let you know anyway that I spoke to an expert on Graves today who said people with either Graves or hypothyroidism both do have predispositions to nerve disorders like carpal tunnel syndrome. See my separate post lower down on the board if you’re interested.

I am sorry for your son. I feel awfully young to have painful hands that are barely useful myself. Hopefully you will find a treatment.

[Author]

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