Síndrome de Guillain Barré asociado a enfermedad de Graves: rol de la plasmaféresis en la patología tiroidea autoinmune

Abstract

A 36 year old woman was seen in the emergency service due to paresis in the lower limbs, combined with diarrhea and abdominal pain in the previous ten days. The neurological examination showed proximal strength 4/5 and distal strength 3/5 in all the muscular groups, with hyporeflexia in the lower left limb. The electromyography showed demyelinating motor neuropathy with predominance in the lower limbs, confirming Guillain-Barré. During admission, the patient had low TSH levels, high free T4 levels, and elevated Tc-99m pertechnetate thyroid uptake, leading to the diagnosis of Graves’ disease. Both diseases are caused by autoimmunity. This is the second case reported in the literature demonstrating this. Plasmapheresis was helpful in neurological symptoms but not in the thyroid disease, questioning the role of plasmapheresis in the treatment of autoimmune thyroid disease. Both diseases are caused by autoimmunity; therefore plasmapheresis was an option in Guillain-Barré, but not in Graves’ disease.