Two Cases of Graves' Disease With Signs of a Pyramidal Lesion. Improvement in Neurologic Signs During Treatment With Antithyroid Drugs

Ravera, John; Cervino, J M; Fernandez, G; Forcade, A. Ferrari; Malosetti, H; Muxi, F; Maggiolo, J; Mussio, J. C.; Fournier,; Rawak, F

doi:10.1210/jcem-20-6-876

Cited by 20 publications

(9 citation statements)

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“…All this raises a question of cranial localization and possible disturbance of metabolism in the brain. Pyramidal tract dysfunction with hyperthyroidism is rarely seen and can present with signs of hyperreflexia, spasticity, and clonus [9, 17]. Along with other neurological manifestations, our patient had clonus and rigidity suggesting pyramidal or corticobulbar tract lesion.…”

Section: Discussionmentioning

confidence: 77%

“…It is unclear to what exacerbates this complication. It evolves rapidly, but the symptoms resolve with the treatment of thyrotoxicosis [9]. …”

Section: Discussionmentioning

confidence: 99%

“…Dysarthria and dysphagia are most common with bulbar involvement [2]. Cases of hyperthyroidism with isolated dysphagia in the absence of anatomic or sensory abnormality have also been reported as far back as 1957 [9]. Some patients may have both lower and upper motor neuron signs [12–15].…”

Section: Discussionmentioning

confidence: 99%

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Acute Thyrotoxic Bulbar Myopathy with Encephalopathic Behaviour: An Uncommon Complication of Hyperthyroidism

Boddu

Badireddi

Straub

et al. 2013

Case Reports in Endocrinology

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Objective. Acute thyrotoxic bulbar palsy is rare, severe, and rapidly progressive. We describe a case of thyrotoxicosis with bulbar palsy, encephalopathy, and pyramidal tract dysfunction. Case Report. 64-year-old white male with toxic multinodular goiter presented with rapid atrial fibrillation. He had mild tremor, normal cranial nerve examination, 4/5 strength in all extremities, normal reflexes, and down going plantars. TSH was low at 0.09 (normal: 0.34–5.6 uIU/mL), and free T4 was high at 5.22 (normal: 0.47–1.41 ng/dL). Despite optimal AV nodal blockade, he had persistent rapid atrial fibrillation. He later developed cervical dystonia, rigidity, clonus, dysarthria, dysphagia, vocal cord palsy, and absent gag reflex. Thyroid storm was suspected. Neuroimaging and cerebrospinal fluid cultures were nondiagnostic. Acetylcholine receptor antibodies were negative. Swallow ability was impaired with heavy secretions. Remarkable improvement in symptoms was noted after initiation of treatment for thyroid storm. Conclusion. Pyramidal tract symptoms and bulbar palsy may occur with thyrotoxicosis. Cranial nerve involvement and encephalopathy raise a question of primary brain mechanism causing bulbar palsy. This is reversible with prompt treatment of thyroid storm.

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Section: Discussionmentioning

confidence: 77%

“…It is unclear to what exacerbates this complication. It evolves rapidly, but the symptoms resolve with the treatment of thyrotoxicosis [9]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute Thyrotoxic Bulbar Myopathy with Encephalopathic Behaviour: An Uncommon Complication of Hyperthyroidism

Boddu

Badireddi

Straub

et al. 2013

Case Reports in Endocrinology

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“…In these cases it is necessary to differentiate TM not only with muscular dystrophy (oculopharengeal (oculopharyngeal) form) but as well with proximal spinal muscular Presence of fasciculations witnesses very convincingly against TM. Pyramidal tract affection in TM patients occurs very rarely [14].…”

Section: Resultsmentioning

confidence: 99%

Differential Diagnosis of Thyrotoxic Myopathy

Kazakov¹,

Скоромец²,

Stuchevskaya³

et al. 2017

OJMIP

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Along with hereditary myopathies, there are many exogenic (the same a not hereditary) muscle affections due to the pathology of endocrine gland's functioning. These forms of muscle pathology are called endocrine myopathies. In the cases of thyroid gland hyperfunction (the same a thyrotoxicosis), different regions of neuromuscular system may be involved in the pathological process. Thyrotoxic myopathy (TM) which is a subject of this investigation, occupies one of the first places between thyrotoxic (the same a thyrotoxicosis) neuromuscular affections. Meanwhile, for a long time in literature there was no clarity about the degree of muscle weakness and atrophy to diagnose TM in a patient. It's because of the fact that the majority of patients complain of increased fatigue and general weakness due to thyrotoxicosis. In present time TM diagnostics is very rare. TM is a phenocopy (the clinical similar) of many neuromuscular diseases. However in literature, the data about peculiarities of clinical picture of TM is almost completely absent, it isn't known about the frequency of affection of the isolated muscles or muscle groups, the topography of muscle weakness and successive involvement of isolated muscles in the pathological process during different stages of thyrotoxicosis and myopathy. The questions of differential diagnosis with similar neuromuscular disorders are described very poorly. In present article, we accent our attention at the clinical differentiation of the TM with other neuromuscular diseases, namely muscular dystrophy, myasthenia gravis, polymyositis, Addison's disease, proximal spinal muscular atrophy, steroid myopathy and neurosis. In our opinion, the early diagnosis of TM may help the diagnosis of thyrotoxicosis in patients who have no classical clinical signs of this disease, i.e. in patients with latent thyrotoxicosis.

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“…Ravera et al 13 also presented two cases of Graves's disease with signs of pyramidal lesion and improvement following antithyroid treatment. The first case had typical signs of Graves disease consistent of exophthalmos, bilateral Graefe's sign, diffuse goitre, tachycardia, cardiovascular instability, palpitation and tremor of the fingers.…”

Section: Discussionmentioning

confidence: 99%

Reversible and unilateral corticospinal tract disease secondary to autoimmune free-T3-thyrotoxicosis

Canepa¹,

Ramalingam

Muhith

2017

BMJ Case Reports

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68-year-old female patient with no significant medical history presents with a 3-month history of progressive neurological symptoms, which began with left eye ptosis, blurred vision and non-painful jaw discomfort, followed by left spastic weakness and hyper-reflexia with positive Babinski and Hoffman signs. An elevated T3 level, a positive peroxidase and an antigraves antibody level led to an ultrasound, which confirmed a sub acute-chronic autoimmune thyroiditis. A nerve conduction studies/electromyogram showed normal motor and sensory velocity conduction with a small amplitude compound motor action potential, indicative of likely axonal damage. Following treatment with carbimazole, the neurological symptoms greatly improved. The authors concluded that the left pyramidal syndrome was secondary to autoimmune free T3-thyrotoxicosis.

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Two Cases of Graves' Disease With Signs of a Pyramidal Lesion. Improvement in Neurologic Signs During Treatment With Antithyroid Drugs

Cited by 20 publications

References 0 publications

Acute Thyrotoxic Bulbar Myopathy with Encephalopathic Behaviour: An Uncommon Complication of Hyperthyroidism

Acute Thyrotoxic Bulbar Myopathy with Encephalopathic Behaviour: An Uncommon Complication of Hyperthyroidism

Differential Diagnosis of Thyrotoxic Myopathy

Reversible and unilateral corticospinal tract disease secondary to autoimmune free-T3-thyrotoxicosis

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