Uses of Antithyroid Antibodies in Nonvascular Hemisensory Impairment

To find out the uses and correlation of antithyroid antibodies in patients with hemisensory impairment. Background: Inday-to-day clinical practice, we have difficulties in managing patients with hemisensory impairment, where the diagnostictests are not supporting clinical localization. Material and methods: All patients, aged 18 years and above, who came to theNeurology Department between February 2018 and August 2019 with either right or left persistent hemisensory impairmentwith or without facial involvement, were included. After the clinical assessment, appropriate investigations (complete bloodcounts, urea, creatinine, electrolytes, thyroid-stimulating hormone [TSH], serum B12, antinuclear antibodies [ANA] profile,perinuclear antineutrophil cytoplasmic antibodies [pANCA], cytoplasmic antineutrophil cytoplasmic antibodies [cANCA],neurolaboratory tests, carotid vertebral arterial Doppler study, magnetic resonance imaging [MRI] brain with magneticresonance angiogram [MRA]/MRI brain with contrast) were done to confirm the diagnosis or to treat accordingly. Patientswith acute stroke, demyelination, hemiplegic migraine and transient ischemic attack (TIA) were excluded. Rest of them wereadvised to undergo serum antithyroid antibodies and psychiatric assessment. Patients with positive antithyroid antibodieswere treated with prednisolone 1 mg/kg/day for 6 weeks and reviewed. Psychiatric follow-up was done in patients withnegative antithyroid antibody reports. Uses and correlation of antithyroid antibodies were analyzed. Results: A totalof 33 patients were studied. Among them, 28 (85%) were females, 5 (15%) males and the mean age of presentation was41.6 years. Out of 33 patients, 27 (82%) had subjective feeling of subacute onset persistent tingling sensation or numbnessor tightness or hypo-/hyperesthesia or uneasiness on either side of the body with or without face involvement. Rest of the6 patients (18%), had numbness with feeling weak on one side with no demonstrable sensory motor deficit. Antithyroidantibodies (antithyroglobulin and antithyroid peroxidase antibodies) were positive in 21 (64%) patients with hemisensoryimpairment. In this study, 28 (85%) were in euthyroid, 3 patients (9%) in hypothyroid and 2 (6%) were in hyperthyroidgroups. Antithyroid antibodies were positive in 61%, 66% and 100%, respectively in the thyroid groups. None of our studypatient had psychiatric illness or brain lesions on MRI study. Conclusion: Autoimmune thyroiditis can present with newonset persistent hemisensory impairment in young adults, which is more common in females. Both antithyroid antibodiesare clinically useful in the diagnosis and management of nonvascular hemisensory impairment. Hence, the strong clinicaljudgment not supported by the diagnostic tests might alert the physician to rule out autoimmune thyroiditis in neuroaxis.