Dear Ask The Doctor: My 30 year-old daughter has been having some serious neurological symptoms, including some loss of motor control in her arms, hands and legs (difficulty opening doors and jars, difficulty walking) some speech issues (searching for words and stuttering) and tingling and numbness in her extremities. She also isextremely fatigued, sleeping up to 16 hours a day. She has a sensation of spiders or ants crawling along her skin, as well as hot flashes and redness, complete with increased sweating. A CT scan showed plaque on her brain, along with a couple of non-specific white abnormalities on her brain. An MRI of her brain was normal, but did show a 1.9 cm nodule on the left side of her thyroid. It also showed some enlarged lymph nodes on her cervical spine. Her thyroid levels are 0.06 and 21.2. An endocrinologist has ordered a thyroid scan that involves drinking a radioactive solution one day, and following up wit X-rays the next. However, a neurologist is leaning towards a diagnosis of MS. The endocrinologist has assured us that th thyroid cannot cause plaque on her brain, but could possibly explain all of her other symptoms. My question is, do you think the thyroid and neurological issues are related, or two incidental illnesses? We're very concerned that the enlarged cervical lymph nodes are indicative of some cancer.
Dear Julie: Multiple sclerosis (MS) is a progressive disease that attacks the central nervous system (CNS) and affects multiple systems of the body through attacks on the nervous system. The disease is characterized initially by episodes of reversible neurologic deficits, which, in most patients, are followed by progressive neurologic deterioration over time. The cause of the disease is not known, but it likely involves a combination of genetic susceptibility and an environmental trigger, resulting in a self-sustaining autoimmune disorder that leads to recurrent immune attacks on the CNS. As you can see, the MS is an autoimmune disease, it will be important to determine the nature of the thyroid problem, if it is just a nodule or if the rest of the gland is affected, if that would be the case an immune cause should be rule out. But if it is not the case the MS and thyroid nodules are not related. And respect the cervical lymph nodes, yes it is important to rule out also a malignant process.