Differences in Thyroid Function and Autoantibodies in the Development of Guillain-Barré Syndrome vs. Chronic Inflammatory Demyelinating Polyradiculoneuropathy.

Xuan Gong,Wenyan Zhuo,Xueying Yu,Zhaoxia Li,Yu Tu,Guanwen Zeng

doi:10.3389/fneur.2020.01018

Abstract

Background: Both Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are neurodegenerative and inflammatory demyelination disorders. Sporadic reports showed that the increased levels of thyroid function and autoantibodies are associated with GBS, CIDP, or both, but no systematic study has been reported. We assessed the differences of thyroid function and autoantibodies between GBS and CIDP in a Chinese cohort.Methods: A total of 256 patients were enrolled in this study. 175 clinically confirmed GBS and CIDP patients were selected. Meanwhile, 81 patients hospitalized for diseases other than GBS or CIDP with mild symptoms were enrolled as a control group. Relevant clinical data, including thyroid function, and autoantibody examinations, were collected for statistical analysis.Results: In the comparison of thyroid function and autoantibody parameters, the levels of total thyroxine (TT4), thyroid peroxidase antibody (TPO-Ab), and thyroglobulin antibody (TG-Ab) in the GBS group were all higher than those in the CIDP and Control groups (P < 0.01). The thyroid antibody positive rates in the GBS and CIDP groups were 70.10 and 14.10%, respectively (P < 0.01). In the receiver operating characteristic (ROC) curve analysis, TT4, TPO-Ab, and TG-Ab were higher in the GBS group and lower in the CIDP group (P < 0.01). To achieve a high specificity of 97–99%, the diagnostic cutoff value of TPO-Ab was higher than 133 IU/mL (Sensitivity: 11.34%) or lower than 0.01 IU/mL (Sensitivity: 9.09%), while the diagnostic cutoff value of TG-Ab was higher than 261.1 IU/mL (Sensitivity: 2.06%) or lower than 0.46 IU/mL (Sensitivity: 11.69%). Multivariate logistic regression analysis showed that the differences in TPO-Ab were statistically significant between GBS patients with TPO-Ab was higher than 133 IU/mL and CIDP patients (P < 0.01); the differences in TG-Ab were statistically significant between GBS patients with TG-Ab was higher than 261.1 IU/mL and CIDP patients (P < 0.05).Conclusion: The elevation of thyroid autoantibodies was associated with GBS. TPO-Ab higher than 133 IU/mL or lower than 0.01 IU/mL and TG-Ab higher than 261.1 IU/mL or lower than 0.46 IU/mL had high specificity for differentiating between GBS and CIDP; therefore, TPO-Ab and TG-Ab can be used as biomarkers for the differential diagnosis of GBS and CIDP.

Highlights

Guillain–Barré syndrome (GBS) is an autoimmune peripheral neuropathy characterized by demyelination of peripheral nerves and nerve roots
Determination Standards of Abnormal Thyroid Functions Based on the Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [4] and the standards used in Beijing Tiantan Hospital, Capital Medical University, the normal values for thyroid functions and autoantibodies were as follows: x serum total thyroxine (TT4): 69.97–152.52 nmol/L; y serum FT4: 7.64–16.03 pmol/L; z serum total triiodothyronine (TT3): 1.01–2.48 nmol/L; { serum FT3: 3.28–6.47 pmol/L; | serum thyroid-stimulating hormone (TSH): 0.49–4.91 μIU/mL; } serum thyroglobulin antibody (TG-Ab): 0–4 IU/mL; and ~ serum Thyroid peroxidase antibody (TPO-Ab): 0–9 IU/mL
Two acute-onset Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) (A-CIDP) patients were identified through dynamic patient follow-up and review

Summary

Introduction

Guillain–Barré syndrome (GBS) is an autoimmune peripheral neuropathy characterized by demyelination of peripheral nerves and nerve roots. The clinical manifestation is acute symmetric flaccid limb paralysis, which usually peaks within 4 weeks of disease onset. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a disease of the peripheral nervous system (PNS) that is clinically characterized by symmetrical proximal and distal weakness with altered sensation and hyporeflexia/areflexia [2]. CIDP exhibits a chronic progression or remission–relapse disease course, and the disease usually peaks 8 weeks after disease onset. Differentiation between CIDP and GBS at the early stage is difficult, as both diseases are easy to misdiagnose. Both Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are neurodegenerative and inflammatory demyelination disorders. We assessed the differences of thyroid function and autoantibodies between GBS and CIDP in a Chinese cohort

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Conclusion