Bilateral chorea–ballism associated with hyperthyroidism

Ristić, Aleksandar J.; Svetel, Marina; Dragašević, Nataša; Žarković, Miloš; Koprivšek, Katarina; Kostić, Vladimir

doi:10.1002/mds.20119

Cited by 47 publications

(27 citation statements)

References 14 publications

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“…In an early report, basal ganglia anatomy was unremarkable at autopsy [6]. This is in line with normal brain imaging in our patient and others [2,4]. The association of chorea with streptococcal infections, systemic lupus erythematosus and antiphospholipid antibody syndrome has led some authors to suggest an autoimmune mechanism for thyrotoxic chorea [7].…”

Section: Discussionsupporting

confidence: 91%

“…Thyrotoxic involuntary movements besides tremor may manifest as classical choreathetosis (as in our patient), paroxysmal chorea [3], paroxysmal kinesigenic chorea [1], bilateral chorea-ballism [4] and hemichorea [5]. The underlying mechanisms of thyrotoxic chorea remain unknown.…”

Section: Discussionmentioning

confidence: 84%

“…Anticardiolipin antibodies were indeed slightly increased in our patient. The prompt effect of levothyroxine reduction, however, may speak against a major physiological contribution of these antibodies and possibly makes a direct effect of thyroxine on the basal ganglia more likely [4]. Dopamine receptor sensitivity is indeed increased in experimental thyrotoxic chorea [8].…”

Section: Discussionmentioning

confidence: 96%

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Choreathetosis due to abuse of levothyroxine

2009

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Choreathetosis due to thyrotoxicosis is a rare movement disorder of acute onset. Here we present the first report of choreathetosis secondary to abuse of levothyroxine. A 35-year-old woman with autoimmune thyroiditis tripled her daily levothyroxine intake and lost 20 kg of weight during the following 6 months. She soon developed incapacitating choreathetosis. When levothyroxine was reduced to her usual dosage, all symptoms vanished in 7 days. The prompt effect of dose correction points towards a direct influence of levothyroxine on the basal ganglia; alternatively, the effects of levothyroxine might have been indirect and, possibly, autoimmune-mediated. Abuse of levothyroxine and related thyroid-tropic substances should be included into the differential diagnosis of acute choreathetosis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 96%

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Choreathetosis due to abuse of levothyroxine

2009

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“…3 Although most cases involve Grave's disease, a few reports of chorea due to iatrogenic thyrotoxicosis have been published. 7 The pathophysiology of hyperthyroidism-related chorea is poorly understood, which is not surprising in view of the wide range of metabolic pathways affected by thyroid hormones.…”

mentioning

confidence: 99%

“…It has been suggested that thyroid hormones could functionally affect the dopaminergic system within the basal ganglia, possibly through an increased sensitivity of the dopaminergic receptors. 3 However, thyroid hormones also play an important role in regulating central noradrenergic, serotoninergic, and cholinergic systems, and complex interactions may occur. 8,9 Furthermore, thyroid hormones also control gene expression in the nervous central system.…”

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confidence: 99%

Reversible chorea in association with Graves' disease and moyamoya syndrome

et al. 2008

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Hyperthyroidism and moyamoya syndrome (MMS) are rare causes of chorea. 1 Here, we report a patient who had chorea associated with both conditions.A 19-year-old woman from Ivory Coast was admitted because of movement disorder. There was no family history of neurological diseases. The patient had been diagnosed with Graves' disease at age 18 and had since showed poor compliance with carbimazole therapy. Upon admission, free thyroxine level was more than 100 pmol/L (range 12-23), thyroid stimulating hormone was undetectable (less than 0.001 mUI/L, range 0.3-4.4), and thyroid stimulating antibodies were positive: 21.1 UI/L. About 2 weeks before admission, she had progressively developed movement disorder, balance impairment, and dysarthria. On examination, the patient had a diffuse goiter and typical signs of thyrotoxicosis, including warm, moist skin, and tachycardia. She had mild and diffuse choreic movements, predominating in the facial area. Movements involved symmetrically both upper limbs, mainly in sustained posture. The patient had mild dysarthria and tandem walk was impaired. Mild slowing of alternating movements of both hands was present. Neurological examination was otherwise normal. Routine blood count, electrolytes, urea, creatinine, liver function panel, were all normal. Autoantibody screen was negative for anticardiolipids, lupus anticoagulant, Antibeta2GP1, antinuclear antibody, and anti dsDNA antibody. Brain magnetic resonance imaging (MRI) showed high signal intensity lesions on FLAIR and T2 sequences in the left anterior putamen and the head of the left caudate nucleus (Fig. 1). MR angiography showed severe stenosis of the extremity of the internal carotid arteries, at the origin of both middle cerebral arteries, as well as of the left anterior cerebral artery. Four-vessel cerebral angiography showed bilateral severe stenosis of the supraclinoid portion of the internal carotid arteries with MMS (Fig 2.). Treatment with carbimazole (20 mg/day) and levothyroxine (synthetic T4) 50 g/ day was resumed, in association with propanolol. Clinical signs of thyrotoxicosis and neurological symptoms subsided within a few weeks. Three months later, the patient had normal neurological examination and her thyroid tests results were normal. Because of poor observance, two relapses occurred in the following year, consisting of the reappearance of clinical signs of hyperthyroidism and chorea. Thyroidectomy was finally performed and the patient has since remained free of symptoms.The association of hyperthyroidism and chorea has been reported in several patients. 2-6 A causal relationship is likely, as

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Thyroid Disorders and Movement Disorders—A Systematic Review

Schneider

Tschaidse

Reisch

2023

Movement Disord Clin Pract

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Background There is overlap between movement disorders and neuroendocrine abnormalities. Objectives and methods To provide a systematic review on the association of thyroid dysfunction and movement disorders. Thyroid physiological function and classical thyroid disorders highlighting typical and atypical manifestations including movement disorders, as well as diagnostic procedures, and treatments are discussed. Results Hypothyroidism may be associated with hypokinetic and hyperkinetic disorders. There is debate whether their concomitance reflects a causal link, is coincidence, or the result of one unmasking the other. Hypothyroidism‐associated parkinsonism may resemble idiopathic Parkinson's disease. Hypothyroidism‐associated hyperkinetic disorders mainly occur in the context of steroid‐responsive encephalopathy with autoimmune thyroiditis, that is, Hashimoto disease, mostly manifesting with tremor, myoclonus, and ataxia present in 28–80%, 42–65% and 33–65% in larger series. Congenital hypothyroidism manifesting with movement disorders, mostly chorea and dystonia, due to Mendelian genetic disease are rare. Hyperthyroidism on the other hand mostly manifests with hyperkinetic movement disorders, typically tremor (present in three quarters of patients). Chorea (present in about 2% of hyperthyroid patients), dystonia, myoclonus, ataxia and paroxysmal movement disorders, as well as parkinsonism have also been reported, with correlation between movement intensity and thyroid hormone levels. On a group level, studies on the role of thyroid dysfunction as a risk factor for the development of PD remain non‐conclusive. Conclusions In view of the treatability of movement disorders associated with thyroid disease, accurate diagnosis is important. The pathophysiology remains poorly understood. More detailed case documentation and systematic studies, along with experimental studies are needed.

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Bilateral chorea–ballism associated with hyperthyroidism

Cited by 47 publications

References 14 publications

Choreathetosis due to abuse of levothyroxine

Choreathetosis due to abuse of levothyroxine

Reversible chorea in association with Graves' disease and moyamoya syndrome

Thyroid Disorders and Movement Disorders—A Systematic Review

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