Clinical features of hyperthyroidism combined with Moyamoya disease(report of 4 cases)

Objective To explore the clinical features of hyperthyroidism combined with Moyamoya disease. Methods The manifestations of clinic and neuroimaging in 4 patients with hyperthyroidism combined with Moyamoya disease were retrospectively analyzed.Results 4 patients were young or middle-aged females and onset of the disease were acute or subacute. 2 cases had the history of hyperthyroidism for 4 and 1 years and other 2 cases were diagnosed of hyperthyroidism in the duration of hospital stay. All of them presented with focal neurologic deficit(3 of motor weakness or fatigue in the limbs, 2 of facial paralysis and 2 of aphasia). All of them had thyromegaly Ⅰ°～Ⅱ° and 1 of them had vascular murmur in thyroid region.Thyroid function tests revealed thyrotoxicosis, the level of fT3 was 10.1～30.8 pmol/L,the level of fT4 was 17.9～154.8 pmol/L, the level of TSH was 0.01～0.1 mU/L.DSA or MRA showed stenosis or occlusion of the terminal portions of the bilateral or unilateral internal carotid arteries and abnormal vascular network in the vicinity of the arterial occlusion. The patients recovered after the anti-thyroid therapy and treatments for the cerebral stroke. Then ,15 ～ 60 months were followed up respectively, there was no relapsed of cerebral stroke in them. Conclusion Hyperthyroidism combined with Moyamoya disease is only seen in females. Cerebral stroke is occurred during the presence of thyrotoxicosis. Anti-thyroid treatment is beneficial for recovery of the centre nervous system and prevention of recurrence.