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Idrissi S, Velucci V, Esposito M, Trinchillo A, Habestwallner F, Belvisi D, Fabbrini G, Ferrazzano G, Rizzo V, Terranova C, Girlanda P, Pellicciari R, Avanzino L, Di Biasio F, Marchese R, Bono F, Idone G, Laterza V, Lettieri C, Rinaldo S, Eleopra R, Castagna A, Altavista MC, Moschella V, Erro R, Barone P, Barbero P, Ceravolo R, Mazzucchi S, Mascia MM, Ercoli T, Muroni A, Zibetti M, Lopiano L, Scaglione CLM, Bentivoglio AR, Petracca M, Magistrelli L, Cotelli MS, Cossu G, Squintani GM, De Santis T, Schirinzi T, Misceo S, Pisani A, Berardelli A, Defazio G. Does thyroid diseases contribute to the natural history of idiopathic adult-onset dystonia? Data from the Italian Dystonia Registry. J Neural Transm (Vienna) 2024; 131:369-375. [PMID: 38376582 DOI: 10.1007/s00702-024-02753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
A few earlier observations and recent controlled studies pointed to the possible contribution of thyroid diseases in idiopathic adult-onset dystonia (IAOD). The aim of this study was to investigate the association between thyroid status and clinical characteristics of IAOD, focusing on dystonia localization, spread, and associated features such as tremors and sensory tricks. Patients were identified from those included in the Italian Dystonia Registry, a multicentre dataset of patients with adult-onset dystonia. The study population included 1518 IAOD patients. Patients with hypothyroidism and hyperthyroidism were compared with those without any thyroid disease. In the 1518 IAOD patients, 167 patients (11%; 95% CI 9.5-12.6%) were diagnosed with hypothyroidism and 42 (2.8%; 95% CI 1.99-3.74) with hyperthyroidism. The three groups were comparable in age at dystonia onset, but there were more women than men in the groups with thyroid disease. Analysing the anatomical distribution of dystonia, more patients with blepharospasm were present in the hyperthyroidism group, but the difference did not reach statistical significance after the Bonferroni correction. The remaining dystonia-affected body sites were similarly distributed in the three groups, as did dystonia-associated features and spread. Our findings provided novel information indicating that the high rate of thyroid diseases is not specific for any specific dystonia subpopulation and does not appear to influence the natural history of the disease.
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Affiliation(s)
- Sarah Idrissi
- Department of Translational Biomedicine and Neuroscience (DiBraiN), "Aldo Moro" University of Bari, Bari, Italy.
| | - Vittorio Velucci
- Department of Translational Biomedicine and Neuroscience (DiBraiN), "Aldo Moro" University of Bari, Bari, Italy
| | | | - Assunta Trinchillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II" University, Naples, Italy
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | | | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberta Pellicciari
- Department of Translational Biomedicine and Neuroscience (DiBraiN), "Aldo Moro" University of Bari, Bari, Italy
| | - Laura Avanzino
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Francesco Bono
- Centre for Botulinum Toxin Therapy, Neurologic Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Giovanni Idone
- Centre for Botulinum Toxin Therapy, Neurologic Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Vincenzo Laterza
- Centre for Botulinum Toxin Therapy, Neurologic Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Christian Lettieri
- Clinical Neurology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Sara Rinaldo
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Castagna
- IRCCS, Don Carlo Gnocchi Foundation Onlus, Milan, Italy
| | | | | | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | | | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Tommaso Ercoli
- Neurology Unit, University Hospital of Cagliari, Cagliari, Italy
| | - Antonella Muroni
- Neurology Unit, University Hospital of Cagliari, Cagliari, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | | | - Martina Petracca
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Magistrelli
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Eastern Piedmont, Novara, Italy
| | | | - Giovanni Cossu
- Neurology Service and Stroke Unit, Department of Neuroscience, AO Brotzu, Cagliari, Italy
| | - Giovanna Maddalena Squintani
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tiziana De Santis
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Antonio Pisani
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience (DiBraiN), "Aldo Moro" University of Bari, Bari, Italy
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Xu Y, Zhao L, Dong J, Jiang J, Jin L. Pathogenic SCN5A Mutation and Thyrotoxicosis-Related Neurological Syndrome: Casual or Causal Relationship? Brain Sci 2023; 13:1049. [PMID: 37508981 PMCID: PMC10377684 DOI: 10.3390/brainsci13071049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Various neurologic complications of hyperthyroidism are reported, and most of these complications are reversible with the amelioration of thyrotoxicosis. We report a previously undescribed concurrence of hyperthyroid-associated exercise-induced myalgia and stiffness, pyramidal tract dysfunction, and myoclonic movements that make an initial clinical diagnosis difficult. CASE PRESENTATION A 17-year-old male was hospitalized in the department of neurology, presenting with a 4-year history of severe exercise-induced myalgia and stiffness, weakness of lower limbs, and myoclonic movements. Laboratory investigations unexpectedly revealed hyperthyroidism. MRI of the brain and spine, electrophysiology, and whole exome sequencing were also performed. Antithyroid therapy led to marked improvement of neurologic symptoms, accompanied by a significant improvement of the time-dependent decline in compound muscle action potentials (CMAP) amplitudes after exercise and normalization of the prolonged QTc interval. Genetic analysis identified a rare variant in SCN5A. CONCLUSION This case report provides important insights into the relationship between hyperthyroidism and neurologic/cardiac complications, particularly in those with a genetic predisposition. SCN5A mutation possibly plays a role in the complex neurological syndrome associated with hyperthyroidism. Further studies are warranted to better understand the underlying mechanisms and potential therapeutic options for these complex conditions.
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Affiliation(s)
- Yangqi Xu
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Lin Zhao
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Jihong Dong
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Jingjing Jiang
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Lirong Jin
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
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Schneider SA, Tschaidse L, Reisch N. Thyroid Disorders and Movement Disorders-A Systematic Review. Mov Disord Clin Pract 2023; 10:360-368. [PMID: 36949803 PMCID: PMC10026317 DOI: 10.1002/mdc3.13656] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
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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Affiliation(s)
| | - Lea Tschaidse
- Medizinische Klinik und Poliklinik IVKlinikum der Universität MünchenMunichGermany
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IVKlinikum der Universität MünchenMunichGermany
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Zheng J, Wu X. Chorea: An unusual manifestation of endocrine diseases. Front Endocrinol (Lausanne) 2023; 14:1155638. [PMID: 36936169 PMCID: PMC10020596 DOI: 10.3389/fendo.2023.1155638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Chorea is a movement disorder involving involuntary movements of muscles of the face, neck, and limbs, usually caused by basal ganglia lesions. As an important part of the presentation of many neurological diseases, chorea is also an unusual manifestation of endocrine diseases and can be challenging to diagnose. Although the most common etiology of chorea is genetic, it is vital to identify acquired or symptomatic chorea, as these are potentially treatable conditions. This review summarizes the latest developments in various endocrine disease-related chorea, which will help clinicians to correctly identify and accurately treat it.
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Anti-Thyroid Peroxidase/Anti-Thyroglobulin Antibody-Related Neurologic Disorder Responsive to Steroids Presenting with Pure Acute Onset Chorea. Tremor Other Hyperkinet Mov (N Y) 2020; 10:19. [PMID: 32775033 PMCID: PMC7394228 DOI: 10.5334/tohm.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Pure acute onset chorea without encephalopathy has rarely been reported in anti-thyroid peroxidase (anti-TPO)/anti-thyroglobulin (anti-TG) antibody-related neurologic disorders responsive to steroids (ATANDS). Case report: We report a 16-year-old female who presented with acute chorea without encephalopathy. Anti-TPO antibodies were found to be strongly positive (>1200 IU/ml) along with anti-thyroglobulin and anti-thyroid stimulating hormone receptor antibodies. After pulse intravenous methylprednisolone therapy (1 g/day for five consecutive days), all the movements seized, and she was discharged with oral prednisolone 30 mg/day with gradual tapering over next three months. After one year of follow-up, she is stable, drug-free, and never had any other problems. Discussion: Anti-thyroid antibodies testing should be included in routine/conventional panel that is done for elucidating causes of chorea as ATANDS can be easily missed and is treatable with widely available, relatively low-cost drugs like steroids with a promising outcome.
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Delhasse S, Debove I, Arnold-Kunz G, Ghika JA, Chabwine JN. Erratic movement disorders disclosing Graves' disease and paralleling thyroid function but not autoantibody levels. J Int Med Res 2019; 47:1378-1386. [PMID: 30761931 PMCID: PMC6421382 DOI: 10.1177/0300060518816873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022] Open
Abstract
Graves’ disease (GD) is an autoimmune pathology characterized by hyperthyroidism and the presence of specific anti-thyroid antibodies. Neurological symptoms such as seizures, cognitive impairment, and tremor can be observed during the course of GD, but more complex movement disorders such as chorea and myoclonus are less frequent. The mechanisms underlying movement disorders in GD are not fully understood. While some authors relate movement disorders to thyroid dysfunction, others claim an autoimmune origin. We herein report a case involving a 60-year-old woman who presented with erratic, intricate movement disorders for which a medical workup revealed GD. During the 2-year follow-up period, her neurological symptoms evolved in parallel with her thyroid function, but not with her autoimmune anti-thyroid antibody level. Her neurological symptoms completely disappeared when she became euthyroid. We herein discuss the complicated clinicobiological relationship between thyroid function and movement disorders. This relationship involves several factors, including the impact of radioactive treatment. The present case emphasizes the importance of including thyroid function screening in the workup of unexplained movement disorders.
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Affiliation(s)
- Sébastien Delhasse
- Internal Medicine Division, Department of Internal Medicine and
Geriatrics, Valais Hospital, Sion, Switzerland
| | - Ines Debove
- Department of Neurology, Bern University Hospital, Bern,
Switzerland
| | - Gabriella Arnold-Kunz
- External consultant in endocrinology; Department of Internal
Medicine and Geriatrics, Valais Hospital, Sion, Switzerland
| | - Joseph-André Ghika
- Neurology Unit, Department of Internal Medicine and Geriatrics,
Valais Hospital, Sion, Switzerland
| | - Joelle Nsimire Chabwine
- Neurology Unit, Department of Internal Medicine and Geriatrics,
Valais Hospital, Sion, Switzerland
- Neurology Unit, Medicine Section, Department of Neuroscience and
Movement Science, Faculty of Science and Medicine, University of Fribourg,
Fribourg, Switzerland
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7
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Kelly DM, Lynch T, Casserly LF. Abdominal tremor in thyrotoxicosis. Neurology 2017; 89:1424-1425. [PMID: 28821688 PMCID: PMC10681063 DOI: 10.1212/wnl.0000000000004403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/26/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dearbhla M Kelly
- From the University Hospital Limerick (D.M.K., L.F.C.); and Dublin Neurological Institute at the Mater Misericordiae University Hospital (T.L.), Dublin, Ireland.
| | - Tim Lynch
- From the University Hospital Limerick (D.M.K., L.F.C.); and Dublin Neurological Institute at the Mater Misericordiae University Hospital (T.L.), Dublin, Ireland
| | - Liam F Casserly
- From the University Hospital Limerick (D.M.K., L.F.C.); and Dublin Neurological Institute at the Mater Misericordiae University Hospital (T.L.), Dublin, Ireland
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8
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Pimentel J, Chambers M, Shahid M, Chawla R, Kapadia C. Comorbidities of Thyroid Disease in Children. Adv Pediatr 2016; 63:211-26. [PMID: 27426902 DOI: 10.1016/j.yapd.2016.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Janiel Pimentel
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Melissa Chambers
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Madhia Shahid
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Reeti Chawla
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Chirag Kapadia
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA.
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Abstract
Thyroid disorders are common in the general population and in hospitalized patients. Thyroid disease may present first with neurological complications or else may occur concurrently in patients suffering other neurological disorders, particularly those with an autoimmune etiology. For this reason neurologists will commonly encounter patients with thyroid disease. This chapter provides an overview of the neurological complications and associations of disorders of the thyroid gland. Particular emphasis is placed on conditions such as thyrotoxic periodic paralysis and myxedema coma in which the underlying thyroid disorder may be occult leading to a first, often emergency, presentation to a neurologist. Information about clinical features, diagnosis, pathogenesis, therapy, and prognosis is provided. Emphasis is placed on those aspects most likely to be relevant to the practicing neurologist and the interested reader is directed to references to good, recent review articles for further information.
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Affiliation(s)
- Clare A Wood-Allum
- Sheffield Institute for Translational Neuroscience, University of Sheffield and Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield and Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK.
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10
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Andrade Mattar M, da Silva Gordo JM, Radu Halpern AS, Katsuyuki Shinjo S. Camptocormia secundária à polimiosite. REVISTA BRASILEIRA DE REUMATOLOGIA 2013; 53:368-70. [DOI: 10.1590/s0482-50042013000400010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 05/14/2013] [Indexed: 11/21/2022] Open
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Tejera B, Holgado S, Calderón V, Pérez R. Camptocormia: case presentation. REUMATOLOGIA CLINICA 2013; 9:195-196. [PMID: 22771271 DOI: 10.1016/j.reuma.2012.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/28/2012] [Accepted: 05/02/2012] [Indexed: 06/01/2023]
Affiliation(s)
- Beatriz Tejera
- Sección de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
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12
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Asymmetric chorea as presenting symptom in Graves' disease. Neurol Sci 2011; 33:343-5. [PMID: 21796431 DOI: 10.1007/s10072-011-0679-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 06/23/2011] [Indexed: 10/17/2022]
Abstract
Chorea is an involuntary movement disorder characterized by irregular, brief movements that flow from one body part to another in a non-stereotyped fashion. In rare instances, chorea is associated with autoimmune thyroid disease. Most of them have been related with Hashimoto's encephalopathy and few cases have been related with Graves' disease. Most reported cases have been in women with Graves' disease. We describe a 16-year-old male patient with asymmetric chorea as presenting symptom in Graves' disease. He had no family history of neurological disease. Brain imaging, laboratory findings and electroencephalogram demonstrated no abnormality except for thyroid dysfunction which was proved by thyroid function test, sonography and radioiodine uptake scan. Asymmetric chorea improved over months after anti-thyroid medications. This asymmetry could be explained by difference in increased hypersensitivity or by the difference in the number of dopamine receptors, and an asymmetrical breakdown of blood-brain barrier due to their genetic differences.
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14
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Abstract
OBJECTIVE Pattern of sleep in hyperthyroid state / thyrotoxicosis has not been systematically studied. It is being characterized as poor without further elaboration. We analyzed the pattern of sleep in a large sample of individuals with thyrotoxicosis who came to our endocrine center in southern India. MATERIALS AND METHODS We identified individuals with the diagnosis of 'thyrotoxicosis' from our electronic medical record database, and evaluated clinical parameters and pattern of their sleep: difficulty in falling asleep (DFA), difficulty in maintaining sleep (DMS), excess daytime sleepiness). In the first phase, univariate analysis with logistic regression was performed. Multivariate logistic regression was performed in the next phase on variables with a P-value < 0.1: these were considered as potential categories/ variables. RESULTS In model response variable with DFA, multivariate logistic regression predicted that subjects with abnormal appetite (more 1.7 or less 2.2), change in bowel motion (loose 1.5 or constipation 2.8), in mood (easy loss of temper 3.4), change of voice -- hoarse 7.4 or moderately hoarse 3.1), tended to have higher chances of difficulty in falling asleep (DFA). Patients with tremor (yes = 5.4) had greater likelihood of difficulty in maintaining sleep (DMS). CONCLUSIONS Individuals with hyperthyroidism/thyrotoxicosis principally had difficulty in falling asleep DFA, which was related to hyperkinetic features.
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Affiliation(s)
- G. R. Sridhar
- Endocrine and Diabetes Centre, 15-12-15 Krishnanagar, Visakhapatnam-530 002, India
| | - Venkata Putcha
- Accostats Solution UK Ltd, 53 Charlwood Road, Luton LU4 0BT, UK
| | - G. Lakshmi
- Kasturba Medical College, Manipal, India
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Miao J, Liu R, Li J, Du Y, Zhang W, Li Z. Meige's syndrome and hemichorea associated with hyperthyroidism. J Neurol Sci 2009; 288:175-7. [PMID: 19883923 DOI: 10.1016/j.jns.2009.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 10/20/2009] [Accepted: 10/20/2009] [Indexed: 11/25/2022]
Abstract
Movement disorders are known to be associated with hyperthyroidism. However, the association of Meige's syndrome and hemichorea with hyperthyroidism has not been reported. We describe a young Chinese woman with hyperthyroidism, who presented with a unique combination of Meige's syndrome and hemichorea in the left limbs. Both neurologic manifestations were preceded by symptoms of hyperthyroidism, and resolved following treatment with methimazole for hyperthyroidism. Nevertheless, the neurologic symptoms recurred when she stopped taking methimazole, but abated when she returned to a euthyroid state after additional treatment with methimazole. The evolution of her clinical course indicated that the involuntary movements were in association with hyperthyroidism. This case is the first report of Meige's syndrome and hemichorea in a patient with hyperthyroidism, which raises the likelihood that hyperthyroidism may be a cause of Meige's syndrome and hemichorea. Furthermore, it emphasizes the need for greater attention to thyroid function in those afflicted with involuntary movements in order to optimize clinical management.
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Affiliation(s)
- Jianting Miao
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an City, Shaanxi Province 710038, China
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Affiliation(s)
- Samuel Katsuyuki Shinjo
- Serviço de Reumatologia, Faculdade de Medicina da Universidade de São Paulo – São Paulo. Brazil.
| | | | - Ari Stiel Radu
- Serviço de Reumatologia, Faculdade de Medicina da Universidade de São Paulo – São Paulo. Brazil.
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Seeherunvong T, Diamantopoulos S, Berkovitz GD. A nine year old girl with thyrotoxicosis, ataxia, and chorea. Brain Dev 2007; 29:660-1. [PMID: 17524583 DOI: 10.1016/j.braindev.2007.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 12/28/2006] [Accepted: 04/05/2007] [Indexed: 11/24/2022]
Abstract
Neurologic manifestations are common in patients with thyroid disease. We describe the case of a nine year old girl with Graves disease and the unique combination of chorea and ataxia that both resolved after treatment of hyperthyroidism.
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Affiliation(s)
- Tossaporn Seeherunvong
- Division of Pediatric Endocrinology, The University of Miami Miller School of Medicine, MCCD 3044 A (D-820), 1601 NW 12th Avenue, Miami, FL 33136, USA
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Young B, Driedger A, Wojcik J. Autoimmune thyroid disease and segmental myoclonus. Mov Disord 2007; 22:434-6. [PMID: 17216646 DOI: 10.1002/mds.21279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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19
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Tan EK, Chan LL. Movement disorders associated with hyperthyroidism: Expanding the phenotype. Mov Disord 2006; 21:1054-5. [PMID: 16615065 DOI: 10.1002/mds.20883] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Thiel R. Might calcium disorders cause or contribute to myoclonic seizures in epileptics? Med Hypotheses 2006; 66:969-74. [PMID: 16439065 DOI: 10.1016/j.mehy.2005.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 11/17/2005] [Indexed: 11/22/2022]
Abstract
Although epilepsy is not rare, many epileptic conditions are considered to be idiopathic and the related seizures of unknown origin. It does appear that different types of seizures are caused by differing mechanisms. This paper discusses scattered case reports involving problems with calcium metabolism and the thyroid, and/or the parathyroid glands concurrent with seizures that support the position that calcium control mechanisms may have been involved in causing seizures in those patients. This paper hypothesizes that calcium levels can cause, or at least contribute to myoclonic (jerk) seizures, as well as to possibly infantile spasms. As these conditions are difficult to treat medically, this paper suggests that nutritional interventions, such as supplemental calcium, magnesium and/or vitamin D, might well be considered as an option as a first-line treatment in those with these types of epileptic disorders. The nutritional recommendations also would apply for those who have seizures concurrent with Down syndrome.
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Affiliation(s)
- R Thiel
- Center for Natural Health Research, Down-Syndrome Epilepsy Foundation, Arroyo Grande, CA 93420, USA.
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Abstract
We describe cervical dystonia occurring in a 31-year-old, previously well, primigravid, primiparous Chinese woman at 4 weeks' amenorrhea, which was ameliorated with low-dose clonazepam and disappeared completely by the end of the second trimester without recurring despite her being tapered off benzodiazepine therapy. Investigations were unremarkable for structural and biochemical causes of dystonia. Chorea, paraballismus, and restless legs syndrome are known to occur during pregnancy, attributable to high estrogen levels. Dystonia, on the other hand, has not been described to occur de novo in pregnancy. This association should be considered in women of reproductive age who present with cervical dystonia.
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