A Case of Graves' Disease Associated with Guillain-Barre Syndrome / 대한내분비학회지

ABSTRACT

Graves disease, an autoimmune endocrine disorder, which causes defects in cellular and humoral immunity, is associated with insulin-dependent diabetes mellitus, Addisons disease, pemicious anemia, and rheumatoid arthritis. Graves disease is associated with various neuro-muscular disorders, such as myopathy, exophalmous oculopathy, periodic paralysis, myastenia gravis and rarely Guillain-Barre syndrome. Guillain-Barre syndrome is considered as an autoimmune disease which can occur concurrently with other autoimmune disorders. This syndrome is characterized by segmental demyelination and axonal degeneration in electrophysiology due to autoantibody to nervous systems via cellular and humoral autoimmunity. In Graves disease, the exact mechanism of the associated Guillain-Barre syndrome is not well understood but it is considered that the autoimmunity is the leading cause of development of both diseases. A 37 year-old man had suffered from thyrotoxic symptoms and progressive symmetrical muscular paralysis. In nerve conduction velocity studies, the result shows peripheral neuropathy; axonopathy; myelinopathy; motor nerve and sensory nerve derangement; right first sacral nerve neuropathy; and decreased CMAP amplitude. The patient was treated with propylthiouracil and high dose intravenous immunoglobulin (400mg/kg/day for Sdays). He responded to the therapy well and became euthyroid state with improvement of muscle weakness. We report a case of Graves' disease associated with Guillain-Barre syndrome with brief review of literature which shows a possible relationship between both diseases.