Serum thyroid-stimulating hormone is an independent risk factor of recurrent Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is generally considered to be monophasic, but some patients have recurrences. The purpose of this study was to clarify the possible link between thyroid parameters and recurrent GBS (RGBS) patients in China.

In this retrospective study we enrolled patients who were admitted to the Department of Neurology of The First Affiliated Hospital of Zhengzhou University from 2014 to 2020 and fulfilled the diagnostic criteria of GBS or Miller Fisher syndrome. We evaluated clinical characteristics; cerebrospinal fluid parameters; and serum levels of thyroid-stimulating hormone (TSH), free thyroxine, and free triiodothyronine in 320 individuals, including 302 with monophasic GBS and 18 with recurrent GBS.

Serum levels of TSH in monophasic GBS patients were significantly lower than those in RGBS patients (P < .001), whereas FT3 levels were higher in the monophasic GBS group (P = .022). Age at onset, incidence of antecedent illness, time from onset to nadir, proportion with acute inflammatory demyelinating polyradiculoneuropathy, and Hughes Functional Grading Scale score at nadir were statistically significant between monophasic GBS patients and RGBS patients (P < .05). The multivariate regression analysis revealed that antecedent illness, AIDP, and high TSH were independent risk factors for RGBS. Our receiver-operating characteristic curve analysis showed that the risk of recurrence in GBS patients increases when the TSH concentration is higher than 3.87 μIU/mL.

Our results demonstrate an association between TSH and RGBS. Oxidative stress is one of the possible interpretations for this association.