Moyamoya syndrome associated with Graves’ disease

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  • 甲状腺機能亢進症に合併した類もやもや病

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Abstract

Graves’ disease has been reported to occur in association with Moyamoya syndrome. We report four patients with concurrent Graves’ disease and Moyamoya syndrome which were treated by means of cerebral revascularization surgery at our university hospital between 2007 and 2010. Two patients were male and two were female whose mean age at the time of surgery was 27.5 years (range, 14 to 43 years). All cases had shown clinically suggestive findings of transient ischemic attacks. At the onset, thyroid function was normal in two patients and relatively high in the other two. In all cases, EC-IC bypass and indirect revascularization surgery was performed. Ischemic symptoms resolved after surgery in all cases. In three cases thyroid function remained normal, but the fourth displayed thyrotoxic symptoms (tachycardia etc.) during surgery and subsequently required medication for a thyrotoxic state. In all patients, a postoperative CBF study revealed elevated cerebral perfusion. In general, the transient ischemic symptoms of Moyamoya syndrome disappear after hyperthyroidism is brought under control, and return as hyperthyroidism reappears. These changes could in turn be triggers of the cerebral ischemic attacks in Moyamoya syndrome. This would explain why almost all reported cases of Moyamoya syndrome have exhibited symptoms of thyrotoxic state. Patients whose thyrotoxicosis was incompletely controlled during the perioperative period should receive particular attention with regard to controlling thyroid function. Thyroid functions should remain under strict control, especially given the fact that the perioperative period offers many opportunities for the use of contrast media and iodine-containing medications.

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