Hypothyroidism Presenting with Dysarthria and Intermittent Weakness of the Extremities (P4.047)

Objective: To describe a rare case of hypothyroidism presenting with dysarthria and extremity weakness.

Background: Uncontrolled hypothyroidism can affect the central and peripheral nervous systems causing a range of neurological symptoms. This report demonstrates the importance of evaluating for hypothyroidism in patients presenting with dysarthria and extremity weakness.

Design/Methods: A case report.

Results: The patient was a 56 year-old right-handed male with carotid stenosis, hypothyroidism, hyperlipidemia, and obstructive sleep apnea who presented with dysarthria. He reported the gradual development of slurred speech two weeks prior to admission. Within a week, he developed intermittent weakness of his left hand followed by intermittent weakness of both legs. On admission, he endorsed persistent dysarthria, generalized fatigue and improvement in extremity weakness. General examination was notable for bradycardia and lack of edema. Neurologic examination was remarkable for moderate dysarthria and distal sensory loss in all extremities. Labwork revealed a CK of 2314 U/L which was treated with fluids. Imaging of brain structure and vessels with MRI and CTA was unremarkable. Telemetry revealed asymptomatic bradycardia in the 30s during sleep prompting a Cardiology consultation. Serologies were remarkable for TSH of 126 U/ml and undetectable free thyroxine. The patient noted that he had exhausted his levothyroxine supply a month previously and had not called for a refill. The Endocrinology service recommended physiologic dosing of levothyroxine and stress dose steroids. On the third day of admission, his fatigue and dysarthria had improved. He was discharged home with physiologic dosed steroids and levothyroxine. After three months on levothyroxine, his TSH was within normal range. His dysarthria and fatigue had resolved. Stocking-and-glove sensory loss persisted.

Conclusions: Hypothyroidism has been sparsely described as presenting with dysarthria, with two reported cases to date. This case illuminates the importance of evaluating for reversible causes of dysarthria and weakness, including endocrine disorders such as hypothyroidism.

Disclosure: Dr. Parker has nothing to disclose. Dr. Alobaidy has nothing to disclose. Dr. Tajuddin has nothing to disclose. Dr. Kakkar has nothing to disclose. Dr. Nguyen has nothing to disclose. Dr. Pacheco has nothing to disclose. Dr. Lu has nothing to disclose.