Abstract
Transverse myelitis (TM) is associated with neuromyelitis optica (NMO) and multiple sclerosis (MS). Early recognition of useful parameters may be helpful to distinguish their difference. This retrospective study analyzed thyroid parameters from 243 serum samples (relapse = 128; remission = 115) of 178 patients with demyelinating diseases (NMO, n = 25; TM, n = 48; MS, n = 105). The relationship between thyroid and clinical parameters was analyzed. Patients with NMO and TM had a higher frequency of abnormal thyroid-stimulating hormone (TSH), anti-thyroglobulin antibodies (TG-Ab), and antithyroid peroxidase antibody (TPO-Ab) than MS patients (p<0.05). The level of TSH and TG-Ab returned to normal levels after administration of high-dose intravenous methylprednisolone (p<0.05). In 96 patients (NMO, n = 19; TM, n = 25; MS, n = 52) without treatment, serum levels of TSH, TG-Ab and TPO-Ab were significantly different between patients with and without myelitis (p<0.01). Patients positive for aquaporin-4 (AQP4) antibodies showed higher abnormalities of TSH (p = 0.001), TG-Ab (p = 0.004) and TPO-Ab (p<0.0001) levels than AQP4 antibodies negative patients. Logistic regression analyses revealed independent relationships between TSH (odds ratio [OR] = 33.994; p<0.0001), TG-Ab (OR = 7.703; p = 0.017) and myelitis occurrence in 96 patients at the active stage. In 52 MS patients experiencing their first attack, MS patients with myelitis were associated with TSH abnormalities (OR = 42.778; p<0.0001). This study showed increased abnormalities of thyroid parameters in patients with NMO and TM than in MS patients. MS patients with myelitis also had greater TSH abnormality than in MS patients without myelitis. Abnormal TSH and TG-Ab were independently associated with myelitis occurrence in central nervous system demyelinating disorders.
Highlights
Transverse myelitis (TM) is an inflammatory demyelinating disorder of the spinal cord that has various manifestations [1]
This study demonstrated a relationship between thyroid parameters and demyelinating disease, there was no evidence to indicate that thyroid disease was involved in the three central nervous system (CNS) demyelinating diseases
While multiple sclerosis (MS) and neuromyelitis optica (NMO) are defined as different entities [2], before the definition of NMO diagnostic criteria in 2006 it is likely that some NMO patients were misdiagnosed as MS, resulting in a less accurate analysis
Summary
Transverse myelitis (TM) is an inflammatory demyelinating disorder of the spinal cord that has various manifestations [1]. NMO is a severe, idiopathic, immune-mediated inflammatory, demyelinating and necrotizing disease characterized by transverse myelopathy and optic neuropathy. MS is a chronic demyelinating disease whose lesions disseminate throughout multiple areas in the central nervous system (CNS), including the spinal cord and optic nerves. MS and NMO are considered distinct entities [2]. The identification of aquaporin-4 (AQP4) antibody as a diagnostic criterion [3] for NMO has facilitated its distinction from MS. Details of the pathogenesis of MS and NMO are unknown, and many cases selectively involve the spinal cord and optic nerve. Recognition of useful parameters may be helpful to distinguish the manifestations of MS, NMO and pure TM
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