Abstract Details

Title Grave's Disease Mimicking a Structural Myelopathy

Topic General Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 6-009

Objective To highlight Grave’s disease as a differential diagnosis in patients with asymmetric myelopathic findings through a case report.

Background Several neuromuscular disorders have been associated with Grave’s disease and include myopathy, neuropathy, periodic paralysis, muscle cramps, myasthenia gravis and ophthalmoparesis. Rarely, Grave’s disease can present with upper motor neuron (UMN) signs. In these cases, the UMN signs tend to be symmetric.

Design/Methods

Clinical case, diagnostics, and literature review.

Results A 47-year-old female with psoriatic arthritis, lumbar spondylosis, and migraines presented with tremors in her legs following a fall two months prior. She also complained of leg weakness and right knee numbness. On exam she demonstrated a low amplitude tremor in both legs, right more than left, that stopped with position changes. She had normal strength, patchy sensory deficits in the right leg, and hyperreflexia throughout with sustained clonus on the left and 2 beats of clonus on the right. There was a Hoffman’s sign on the left, and mute plantar responses. There was concern for myelopathy given her recent trauma and history of degenerative changes in the spine. MRI total spine didn't show any significant cord or nerve root compression. MRI brain was unremarkable. EMG and nerve conduction study was normal. Serologic testing for metabolic myelopathies was negative. A thyroid ultrasound was pursued given an abnormality detected on cervical spine imaging, and showed a diffusely enlarged and heterogenous thyroid. Subsequent serologic testing revealed undetectable TSH, elevated T3 and T4, and presence of antibodies consistent with Grave’s Disease. She was started on Methimazole which led to resolution of the subjective weakness, and improvement of tremors and hyperreflexia.

Conclusions

Thyroid disorders, in particular Grave’s disease, should be considered in patients presenting with myelopathic signs and symptoms even if findings are asymmetric and mimic a structural lesion. Neurologic symptoms improve with treatment of the underlying thyroid disease.

Authors/Disclosures
Andre Granger, MD, MBA (Mayo Clinic) PRESENTER	Dr. Granger has nothing to disclose.
Arielle M. Kurzweil, MD, FAAN (NYU)	Dr. Kurzweil has nothing to disclose.