Dados do Trabalho

Título

Acute Chorea Associated With Thyrotoxicosis

RESUMO

Case Report:
A 30 year-old with a three-month history of progressive generalized hyperkinectics movement. She had a prior history of severe anxiety, followed by a diagnosis of depression with psychotic symptoms. The condition persisted even after medical prescription of antipsychotics. Due to significant clinical deterioration and loss of functionality, the family sought neurological care. On admission, was agitated, hypervigilant, disoriented , tearful, feverish, tachycardic and presenting generalized choreoathetotic movement. She also had exophthalmos. After much questioning, family members reported that one year prior to admission, she also had unmeasured hyperthermia episodes, sweating, hair loss, asthenia, significant weight loss and low amplitude tremor of the extremities. ECG showed atrial fibrillation. Burch and Wartofsky index scored 75 points. Initial exams revealed TSH: < 0.01 and T4L > 6. Thyrotoxic crisis was diagnosed and the patient was treated with propylthiouracil, beta-blockers, and corticosteroids. She also received low doses of haloperidol and clonazepam to symptomatic control of chorea. Subsequent examinations showed TRAB > 40. There were positive rheumatologic markers, but no target organ damage, so immunosuppressants were not performed. The patient experienced substantial and progressive improvement of choreic movements after normalization of thyroid function. At the follow-up evaluation choreic movements had completely disappeared

Discussion:
We report a case of a young female patient, with no previous comorbidities, who presented to the hospital with generalized choreic movements due to thyrotoxicosis. She was further diagnosed with Graves disease. Chorea is described as a very rare manifestation, present in less than 2% cases of thyrotoxicosis. Mechanism of chorea in these cases is still poorly established. Previous reported cases suggest that it might be related to dopamine effect on basal ganglia, and to functional modification of adrenergic receptors. Association with autoimmunity has also been described

Final comments:
In conclusion, we enforce the importance of considering hyperthyroidism as a main differential diagnosis of acute chorea. This etiology is identifiable using simple laboratory tests and has a good response to drug treatment. Further studies are needed to elucidate pathophysiology of chorea related to hyperthyroidism and autoimmunity

Palavras Chave

Chorea, Thyrotoxicosis