Objective: We present the case of a 56 years-old female patient that presented chorea movements after the initiation of replacement treatment with thyroid hormones.

Background: A chorea movement in thyrotoxicosis is a rare situation.

Methods: Case presentation.

Results: The patient was diagnosed with myxedema and treatment with thyroid hormones was recommended. About one week from replacement treatment with thyroid hormone initiation, the patient presents chorea-like involuntary movements that affect both upper limbs and the head. 4 months after treatment she was referred to the neurologist. General clinical examination shows tachycardia (112 bpm) and sweat. Neurological clinical examination revealed chorea-like involuntary movements. Intermittently, the movements involve the proximal limbs with a ballism-like character. The patient presents bilateral exaggerated deep tendon reflexes, generalized hypotonic status with no other neurological signs. Neuropsychology reveals emotional instability. There is no personal or familiar history of involuntary movements. Imagistic exploration (CT, MRI, MRA) shows no lesions, no vascular abnormalities. Blood work is normal except TSH level that is under the lower limit. There has been done a reevaluation of the thyroid hormones treatment and once the TSH normalized the involuntary movements gradually disappeared in two weeks.

Conclusions: Clinical context, onset of movement disorder and cessation of the involuntary movements after the normalization of thyroid hormones suggest an important link between these. The case presented here, together with the other few reported before, argue for the inclusion of hyperthyroidism among the differential diagnosis of acute chorea.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/chorea-ballism-drug-induced-in-replacement-treatment-with-thyroid-hormones-case-presentation/