Does Hypothyroidism Affect Post-Operative Outcome of Patients Undergoing Carpal Tunnel Release?
Keywords:
Carpal tunnel syndrome, Hypothyroidism, Boston carpal tunnel syndrome questionnaireAbstract
Introduction: Risk factors associated with Carpal Tunnel Syndrome include repetitive use of hand and wrist, advanced age, obesity, pregnancy, diabetes mellitus and thyroid disease. Decompression of the median nerve is the last treatment of choice usually indicated when negative results to conservative treatments remain for three months. In this study, we aimed to find out whether hypothyroid patients would respond to CTS surgical decompression differently in comparison to healthy individuals.
Methods: This case control study was conducted on patients with CTS in need of surgical release who were refered to Shahid Faghihi hospital, International Branch of Shiraz University of Medical Sciences, Shiraz, Iran from January 2013 to January 2015. 25 hypothyroid and 22 euthyroid patients were recruited. Hypothyroidism was diagnosed based on clinical symptoms and serum TSH level. All patients were followed for 3 weeks after surgery and a Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was completed for them pre and post operation. An electrophysiological study was performed during the same follow up period. Statistical analysis was performed using SPSS version 16.
Results: The CTS grade reported by electrophysiological study, decreased significantly 3 weeks after operation in comparison with preoperative grades (p<0.001). A significant decrease was observed in the immediate postoperative BCTQ scores compared to preoperative (p<0.001). Also a decrease was detected in the three weeks of postoperative follow up compared to immediate postoperative BCTQ scores (p<0.001) and preoperative BCTQ scores (p<0.001). Postoperative BCTQ scores of euthyroid patients decreased more in comparison to hypothyroid patients (p<0.001).
Conclusion: It seems that, hypothyroidism has an effect on postoperative outcome of carpal tunnel release.
References
Pyun SB, Song W, Yoo SD. Slowed conduction velocity of the median sensory nerve across the carpal
tunnel in normal adults. Am J Phys Med Rehabil. 2005; 84(8): 598-603. doi:
1097/01.phm.0000171004.38035.9e. PMID: 16034229.
Viera AJ. Management of carpal tunnel syndrome. Am Fam Physician. 2003; 68(2): 265-72. PMID:
Stevens JC, Beard CM, O'Fallon WM, Kurland LT. Conditions associated with carpal tunnel syndrome.
Mayo Clin Proc. 1992; 67(6): 541-8. PMID: 1434881.
Tunc T, Kutlu G, Coskun O, Okuyucu EE, Çavdar L, İnan LE, et al. Karpal tunel sendromunda klinik ve
elektrofizyolojik evrelemelerin karsilastirilmasi. 2006; 7: 23-6.
You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity
scales and nerve conduction measures in carpal tunnel syndrome. Muscle Nerve. 1999; 22(4): 497-501. doi:
1002/(SICI)1097-4598(199904)22:4<497::AID-MUS11>3.0.CO;2-T. PMID: 10204785.
Oktayoglu P, Nas K, Kilinç F, Tasdemir N, Bozkurt M, Yildiz I. Assessment of the Presence of Carpal
Tunnel Syndrome in Patients with Diabetes Mellitus, Hypothyroidism and Acromegaly. J Clin Diagn Res.
; 9(6): 14-8. doi: 10.7860/jcdr/2015/13149.6101. PMID: 26266148, PMCID: PMC4525537.
Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid
dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry. 2000;
(6): 750-5. doi: 10.1136/jnnp.68.6.750. PMID: 10811699, PMCID: PMC1736982.
Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, et al. Surgery versus non-surgical
therapy for carpal tunnel syndrome: a randomised parallel-group trial. The Lancet. 2009; 374(9695): 1074- 81. doi: 10.1016/S0140-6736(09)61517-8. PMID: 19782873.
Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel
syndrome in a general population. Jama1. 1999; 282(2): 153-8. doi: 10.1001/jama.282.2.153. PMID:
Daniell WE, Fulton‐Kehoe D, Franklin GM. Work‐related carpal tunnel syndrome in Washington State
workers' compensation: Utilization of surgery and the duration of lost work. Am J Ind Med. 2009; 52(12):
-42. doi: 10.1002/ajim.20765. PMID: 19882743.
Witt JC, Hentz JG, Stevens JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle
Nerve. 2004; 29(4): 515-22. doi: 10.1002/mus.20019. PMID: 15052616.
Beghi E, Delodovici M, Bogliun G, Crespi V, Paleari F, Gamba P, et al. Hypothyroidism and
polyneuropathy. J Neurol Neurosurg Psychiatry. 1989; 52(12): 1420-3. doi: 10.1136/jnnp.52.12.1420.
PMID: 2559162, PMCID: PMC1031603.
Arikanoglu A, Altun Y, Uzar E, Acar A, Çevik MU, Demircan F, et al. Klinik ve Subklinik Hipotiroidili
Hastalarda Median ve Ulnar Sinirin Elektrofizyolojik İncelemeleri: Olgu Kontrol Çalışması. Archives of
Neuropsychiatry/Noropsikiatri Arsivi. 2012; 49(4): 304-7.
Gulbun Y, Karlikaya G, Tulin T, Gulseren A. Nerve Conduction Studies, SEP and Blink Reflex Studies in
Recently Diagnosed, Untreated Thyroid Disease Patients. Journal of Neurological Sciences (Turkish).
; 24(1): 007-15.
Somay G, Oflazoğlu B, Us O, Surardamar A. Neuromuscular status of thyroid diseases: a prospective
clinical and electrodiagnostic study. Electromyogr Clin Neurophysiol. 2006; 47(2): 67-78. PMID:
Kececi H, Degirmenci Y. Hormone replacement therapy in hypothyroidism and nerve conduction study.
Neurophysiol Clin. 2006; 36(2): 79-83. doi: 10.1016/j.neucli.2006.04.001. PMID: 16844546.
Shiri R. Hypothyroidism and carpal tunnel syndrome: A meta‐analysis. Muscle & nerve. 2014; 50(6):
-83. doi: 10.1002/mus.24453. PMID: 25204641.
Pomerance J, Zurakowski D, Fine I. The cost-effectiveness of nonsurgical versus surgical treatment for
carpal tunnel syndrome. J Hand Surg Am. 2009; 34(7): 1193-200. doi: 10.1016/j.jhsa.2009.04.034. PMID:
Gerritsen AA, de Krom MC, Struijs MA, Scholten RJ, de Vet HC, Bouter LM. Conservative treatment
options for carpal tunnel syndrome: a systematic review of randomised controlled trials. J Neurol. 2002;
(3): 272-80. doi: 10.1007/s004150200004. PMID: 11993525.
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane
Database Syst Rev. 2007; (2): 1554. doi: 10.1002/14651858.cd001554.pub2. PMID: 17443508.
O'Connor D, Marshall S, Massy-Westropp N. Non‐surgical treatment (other than steroid injection) for
carpal tunnel syndrome. Cochrane Database Syst Rev. 2003; (1): 3219. doi: 10.1002/14651858.cd003219.
PMID: 12535461.
Palumbo CF, Szabo RM, Olmsted SL. The effects of hypothyroidism and thyroid replacement on the
development of carpal tunnel syndrome. J Hand Surg Am. 2000; 25(4): 734-9. doi:
1053/jhsu.2000.8642. PMID: 10913216.
Karpitskaya Y, Novak CB, Mackinnon SE. Prevalence of smoking, obesity, diabetes mellitus, and thyroid
disease in patients with carpal tunnel syndrome. Ann Plast Surg. 2002; 48(3): 269-73. doi:
1097/00000637-200203000-00007. PMID: 11862031.
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