Abstract
IntroductionThe clinical picture of hypothyroidism, including neurological symptoms, can be multiform, which may delay or hamper the correct diagnosis.Case presentationWe present an uncommon clinical presentation of a 38-year-old Caucasian man with mild facial palsy on the left side, uvular deviation to the left with preserved gag reflex, tongue deviation to the left, lingual dysarthria, and xerosis by severe hypothyroidism. Blood tests on admission showed elevated serum creatinine of 151 μmol/L (glomerular filtration rate 47 ml/min/1.7 CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration equation]), increased creatinine phosphokinase activity (1243 U/L), markedly elevated thyroid-stimulating hormone (292.2 mIU/L), low free thyroxine level (1.1 pmol/L), and free triiodothyronine level below the limit of detection (< 0.4 pmol/L). Results of brain magnetic resonance imaging and renal ultrasound were unremarkable. Lumbar puncture revealed a normal cell count in cerebrospinal fluid, with an increased protein level of 758 mg/L and a cerebrospinal fluid/serum albumin ratio of 10.5 × 10− 3/L (reference range < 6.7). Further diagnostic workup did not reveal any inflammatory or infectious systemic pathologies as an underlying cause. The patient’s neurological symptoms, as well as laboratory findings including renal function, creatinine phosphokinase, and initially altered blood lipid levels, normalized with levothyroxine substitution.ConclusionsMultiple cranial neuropathy is an uncommon clinical finding in hypothyroidism, which is an important differential diagnosis in the workup of new neurological deficits.
Highlights
The clinical picture of hypothyroidism, including neurological symptoms, can be multiform, which may delay or hamper the correct diagnosis.Case presentation: We present an uncommon clinical presentation of a 38-year-old Caucasian man with mild facial palsy on the left side, uvular deviation to the left with preserved gag reflex, tongue deviation to the left, lingual dysarthria, and xerosis by severe hypothyroidism
We present a case of a patient with severe hypothyroidism presenting with a rare neurological manifestation
We report an unusual case of severe hypothyroidism due to autoimmune thyroiditis with myxedema, neuromyopathy, and renal affection
Summary
Thyroid hormone (TH) is essential for the function and regulation of cellular metabolism in virtually all mammalian cells. Apart from increasing fatigue and continuous weight gain of almost 20 kg over the last 2 years, his medical and family history was unremarkable His clinical examination revealed a mild lower motor neuron facial palsy on the left, uvular deviation to the left with preserved gag reflex, tongue deviation to the left, lingual dysarthria, and xerosis. His mucous membranes were unremarkable, but his skin was dry His vital parameters were normal apart from an increased body mass index (31.6 kg/m2) and Hepprich et al Journal of Medical Case Reports (2019) 13:180 hypothermic tympanic temperature of 35.6 °C (blood pressure 127/79 mmHg, heart rate 70 beats/min).
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