Thyroid antibodies are associated with stenotic lesions in the terminal portion of the internal carotid artery

• Published in: European journal of neurology Vol. 21; no. 6; pp. 867 - 873
• Main Authors: Tanaka, M., Sakaguchi, M., Yagita, Y., Gon, Y., Yoshikawa, K., Takahashi, T., Fukunaga, R., Mochizuki, H., Kitagawa, K.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-06-2014; John Wiley & Sons, Inc
• Subjects: Adult; Autoantibodies - blood; Carotid Artery, Internal - pathology; Carotid Stenosis - blood; Carotid Stenosis - immunology; Carotid Stenosis - pathology; Female; Graves' disease; Humans; intracranial arterial stenosis; Male; Middle Aged; moyamoya; Moyamoya Disease - blood; Moyamoya Disease - immunology; Moyamoya Disease - pathology; thyroid antibody; Thyroid Diseases - blood; Thyroid Diseases - immunology; Thyroid Diseases - pathology; moyamoya; Graves' disease; thyroid antibody; intracranial arterial stenosis
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.12397

Background and purpose
Several studies have reported moyamoya syndrome associated with thyroid disease, and the mechanism involved in this relationship is unknown. This study aimed to clarify the involvement of thyroid antibodies and thyroid function in intracranial arterial stenosis.
Methods
The study included 30 patients <65 years of age with intracranial arterial steno‐occlusion. Patients with definitive moyamoya disease were excluded. Thyroid function and thyroid antibody levels were evaluated. The steno‐occlusive site and the presence of moyamoya vessels were evaluated using digital subtraction angiography. The characteristics of intracranial arterial lesions were compared between patients with and without elevated thyroid antibody levels, and between patients with increased thyroid function and those with normal thyroid function.
Results
Five patients had increased thyroid function and seven had elevated thyroid antibody levels. Four were diagnosed with Graves' disease, 13 with atherosclerotic intracranial stenosis, two with intracranial arterial dissection, one with vasculitis syndrome and 10 with intracranial stenosis of unknown cause. All patients with Graves' disease and patients with elevated antithyroid peroxidase antibody levels had steno‐occlusion in the terminal portion of the internal carotid arteries, whereas most of the patients with normal thyroid function or without elevated thyroid antibody levels had stenosis in the middle cerebral arteries.
Conclusions
In young and middle‐aged patients, a lesion in the terminal portion of the internal carotid artery was associated with elevated thyroid antibody levels and increased thyroid function. Stenoses found in the terminal portion of the internal carotid artery and immune‐mediated thyroid diseases may share a common background.