Neurological Manifestations of Thyroid Disease Follow-up
- Author: Gabriel Bucurescu, MD, MS; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE more...
Further Outpatient Care
Pregnant patients require follow-up at least monthly. Closely observe these newborns for thyroid disease.
Further Inpatient Care
Neurologic manifestations in thyroid diseases are manageable on an outpatient basis. Therapy is maintained for months (if not years). In most cases, neurologic abnormalities slowly resolve.
Thyroid storm and myxedema coma are exceptions. Both are emergencies that require aggressive treatment in the ICU. The mortality rate of thyroid storm can be as high as 20-40%. The symptoms usually are exaggerated manifestations of the symptoms seen in hyperthyroidism; a superimposed infection and the stress associated with it would exacerbate the symptoms. Fever, abdominal pain, delirium, and psychosis can occur. The patient may become obtunded. Thyroid storm should be suspected in any patient with severe hyperpyrexia, tachycardia, and a goiter.
Prognosis is generally good, since most symptoms are reversible with correction of the underlying problem. Neurologic complications are seldom fatal.
Congenital complications of iodine deficiency lead to cretinism and neonatal myxedema.
Untreated myxedema may lead to myxedema coma and eventually to death in children and adults.
Severity of symptoms of thyroid disease varies with the degree and duration of the deficiency.
Some degree of myopathy is found in about 50% of thyrotoxic patients.
Thyroid storm is an emergency requiring rapid therapy to prevent death.
Although now uncommon, postoperative thyroid disease can be seen.
Cao L, Wang F, Yang QG, Jiang W, Wang C, Chen YP, et al. Reduced thyroid hormones with increased hippocampal SNAP-25 and Munc18-1 might involve cognitive impairment during aging. Behav Brain Res. 2012 Apr 1. 229(1):131-7. [Medline].
Fallah R, Mirouliaei M, Bashardoost N, Partovee M. Frequency of subclinical hypothyroidism in 5- to 15-year-old children with migraine headache. J Pediatr Endocrinol Metab. 2012. 25(9-10):859-62. [Medline].
Song TJ, Kim SJ, Kim GS, Choi YC, Kim WJ. The prevalence of thyrotoxicosis-related seizures. Thyroid. 2010 Sep. 20(9):955-8. [Medline].
Tuncel D, Cetinkaya A, Kaya B, Gokce M. Hoffmann's syndrome: a case report. Med Princ Pract. 2008. 17 (4):346-8. [Medline].
Li L, Zheng FP, Wang G, Li H. Recurrent hashimoto's encephalopathy, showing spontaneous remission: a case report. Intern Med. 2011. 50(12):1309-12. [Medline].
Santoro D, Colombo I, Ghione I, Peverelli L, Bresolin N, Sciacco M. Steroid-responsive Hashimoto encephalopathy mimicking Creutzfeldt-Jakob disease. Neurol Sci. 2011 Aug. 32(4):719-22. [Medline].
Guimaraes J, Santos L, Bugalho P. Painful legs and moving toes syndrome associated with Hashimoto's disease. Eur J Neurol. 2007 Mar. 14(3):343-5. [Medline].
Muthipeedika JM, Moosa A, Kumar A, Suchowersky O. Bilateral chorea--ballism associated with hyperthyroidism. Mov Disord. 2005 Apr. 20(4):512; author reply 512. [Medline].
Chia SY, Chua R, Lo YL, Wong MC, Chan LL, Tan EK. Acute ataxia, Graves' disease, and stiff person syndrome. Mov Disord. 2007 Oct 15. 22(13):1969-71. [Medline].
Ohba S, Nakagawa T, Murakami H. Concurrent Graves' disease and intracranial arterial stenosis/occlusion: special considerations regarding the state of thyroid function, etiology, and treatment. Neurosurg Rev. 2011 Jul. 34(3):297-304; discussion 304. [Medline].
Scorza FA, Arida RM, Cysneiros RM, Terra VC, de Albuquerque M, Machado HR. Subclinical hyperthyroidism and sudden unexpected death in epilepsy. Med Hypotheses. 2010 Apr. 74(4):692-4. [Medline].
Parker RJ, Davidson AC. Hypothyroidism--an unexpected diagnosis following emergency treatment for heatstroke. Int J Clin Pract Suppl. 2005 Apr. 31-3. [Medline].
Blanchin S, Coffin C, Viader F, Ruf J, Carayon P, Potier F, et al. Anti-thyroperoxidase antibodies from patients with Hashimoto's encephalopathy bind to cerebellar astrocytes. J Neuroimmunol. 2007 Dec. 192(1-2):13-20. [Medline].
Sellner J, Kalluri SR, Cepok S, Hemmer B, Berthele A. Thyroid antibodies in aquaporin-4 antibody positive central nervous system autoimmunity and multiple sclerosis. Clin Endocrinol (Oxf). 2011 Aug. 75(2):271-2. [Medline].
Avramides A, Papamargaritis K, Mavromatis I, et al. Visual evoked potentials in hypothyroid and hyperthyroid patients before and after achievement of euthyroidism. J Endocrinol Invest. 1992. 15:749-753. [Medline].
Ozata M, Ozkardes A, Corakci A, Gundogan MA. Subclinical hypothyroidism does not lead to alterations either in peripheral nerves or in brainstem auditory evoked potentials (BAEPs). Thyroid. 1995. 5(3):201-205. [Medline].
Ozkardes A, Ozata M, Beyhan Z, et al. Acute hypothyroidism leads to reversible alterations in central nervous system as revealed by somatosensory evoked potentials. Electroencephalography and clinical neurophysiology. 1996. 100:500-504. [Medline].
Tamburini G, Tacconi P, Ferrigno P, et al. Visual evoked potentials in hypothyroidism: a long-term evaluation. Electromyogr Clin Neurophysiol. 1998. 38:201-205. [Medline].
Sinclair C, Gilchrist JM, Hennessey JV, Kandula M. Muscle carnitine in hypo- and hyperthyroidism. Muscle Nerve. 2005 Sep. 32(3):357-9. [Medline].
Alevizaki M, Synetou M, Xynos K, Alevizaki CC, Vemmos KN. Hypothyroidism as a protective factor in acute stroke patients. Clin Endocrinol (Oxf). 2006 Sep. 65(3):369-72. [Medline].
Dai A, Wasay M, Dubey N, Giglio P, Bakshi R. Superior sagittal sinus thrombosis secondary to hyperthyroidism. J Stroke Cerebrovasc Dis. 2000 Mar-Apr. 9(2):89-90. [Medline].
Ni J, Gao S, Cui LY, Li SW. Intracranial arterial occlusive lesion in patients with Graves' disease. Chin Med Sci J. 2006 Sep. 21(3):140-4. [Medline].
Peralta AR, Canhão P. Hypothyroidism and cerebral vein thrombosis--a possible association. J Neurol. 2008 Jul. 255(7):962-6. [Medline].