Objective: To present a case with recurrent attacks of ataxia in a young lady with Hashimoto’s Thyroidits.

Background: Hashimoto’s thyroiditis is now considered the most common autoimmune disease (1). Hypothyroidism has been described as a cause of gait ataxia, presumably due to cerebellar dysfunction although the exact mechanism by which it might produce this syndrome is unclear. In most reported cases, the ataxia has been reversed by thyroid replacement therapy suggesting that it was caused by the metabolic effects of the hormonal deficiency (2).

Methods: Case report

Results: A 26- year- old normotensive, nondiabetic left handed lady presented with recurrent episodes of gait ataxia of about 2 months’ duration. Firstly she noted clumsiness of her hands with difficulty in writing, buttoning up of clothes, and pouring from a teapot. She also noticed imbalance and tendency to fall. Neurologically, she was fully oriented with intact neurological function except bilateral cerebellar features. Interestingly Brain MRI disclosed nothing favouring any demyelinating, infectious or vascular lesion. She was then diagnosed as a case of Bilateral cerebellar ataxia due to Suspected first isolated attack of MRI negative MS and therapy with high dose Methylprednisolone ( 1g/day) for 3 days followed by oral prednisolone was given. There was rapid improvement of her symptoms and she was discharged with tapering dose of steroid for 14 days. Four days later, she agin developed same type of ataxic attack. Thyroid profile was thoroughly investigated again and found FT3: 3.58 (Ref: 2.8-9.5 pmol/L), FT4: 20.59 (Ref: 9.5-25.5 pmol/L), TSH: 5.02 (Ref: 0.3-5.0mIU/L), normal anti-thyroglobulin antibody (TGAb): 6.62% (Ref:<30%), Very high anti-thyoid peroxidase antibody (TPOAb): 1262U/ml (Ref: <15U/ml). After consultation with Endocrinolgy department, she was then finally diagnosed as a case of bilateral cerbellar ataxia due to autoimmune (Hashimoto’s) Thyroiditis. She recovered dramatically within a week and remain stable after 2 months of discharge with 25ug levo thyroxine and 10 mg prednisolone. Now her thyroid profile including thyroid auto-antibodies are within normal limit.

Conclusions: Classical signs of hypothyroidism may not be obvious in patients with ataxia. We recommend testing for thyroid functions and antithyroid antibodies as appropriate and other evidence of autoimmunity in patients who present with subacute or recurrent cerebellar ataxia.

References: 1. Jacobson DL, Gange SJ, Rose NR, Graham NM. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol 1997; 84:223–43. 2. Söderbergh G. Encore un cas de myxoedeme avec symptomes cerebelleux. Rev Neurol (Paris) 1911; 22:86–9.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/recurrent-ataxia-in-a-young-lady-with-hashimotos-thyroiditis/