Peripheral Nerves’ Involvement in Controlled & Uncontrolled Hypothyroidism: An Electrodiagnostic Study

Ali Abdulghani, Amina; Bader Hamdan, Farqad; Mahdi Rahmah, Abbas

doi:10.52573/ipmj.2025.162851

	Peripheral Nerves’ Involvement in Controlled & Uncontrolled Hypothyroidism: An Electrodiagnostic Study
Iraqi Postgraduate Medical Journal
Volume 25, Issue 2, April 2026, Pages 136-144 PDF (4.43 M)
Document Type: Research Paper
DOI: 10.52573/ipmj.2025.162851
Authors
Amina Ali Abdulghani^* ¹; Farqad Bader Hamdan²; Abbas Mahdi Rahmah³
¹Department of Neurophysiology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq.
²Department of Medical Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
³National Diabetes Center, Al-Mustansiriyah University, Baghdad, Iraq.
Abstract
Background: Hypothyroidism arises from reduced thyroid hormone production or activity due to dysfunction of the hypothalamic-pituitary-thyroid axis. Peripheral polyneuropathy is caused by axonal or myelin sheath damage. This study aimed to explore the neurophysiological impact of hypothyroidism, not to test an intervention. Methods: A cross-sectional observational study was conducted from March to December 2024, involving 50 female hypothyroid patients aged 20–75 years. Patients were divided into controlled (n = 14) and uncontrolled (n = 36) groups. All underwent motor and sensory nerve conduction studies (NCS), F-wave analysis, sural-radial amplitude ratio (SRAR), and needle EMG. Peripheral neuropathy was diagnosed based on reduced SNAP and/or CMAP amplitudes in a length-dependent pattern, while CTS was identified using standard diagnostic criteria including prolonged distal motor latency and reduced median SNAP amplitude. Results: While age and etiology of hypothyroidism were similar between groups, disease duration was significantly shorter in uncontrolled patients (p = 0.007). 22 patients had peripheral neuropathy, 14 had carpal tunnel syndrome, and 14 had normal neurophysiological findings. Uncontrolled patients showed significantly reduced SNAP and CMAP amplitudes across multiple nerves (p < 0.05) and lower SRAR (p < 0.001). In the uncontrolled group, TSH was inversely associated with sural SCV (r = –0.480; p = 0.004) and positively with median DML (r = 0.364; p = 0.032). Conclusion: Despite shorter disease duration, uncontrolled hypothyroid patients showed more peripheral nerve issues possibly indicating subclinical disease. Better metabolic control improves neurophysiological outcomes. Regular thyroid hormone and nerve tests are vital for early detection and prevention. Proper hormonal management is key for metabolic health and nerve integrity.
Keywords
Disease severity; Electromyography; Hypothyroidism; Nerve conduction studies; Peripheral neuropathy

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