Objective: To describe the first report of Cervical Dystonia and Choreoatetosis associated in the same patient with hyperthyroidism (thyrotoxicosis).

Background: Thyroid Disease is related with movement disorders being the tremor the most common of them. In less than 2 percent of patients with hyperthyroidism, hyperkinetic Movement Disorders, related to autoimmune and iatrogenic hyperthyroidism, have been described in literature. Chorea typically is generalized and focal dystonia is also rare. In this case the evolution of her clinical course indicated that the involuntary movements were in association with hyperthyroidism. It previously has been postulated that elevated thyroid hormones may affect the dopaminergic system, with changes in motor neuron excitability or motor system organization. Experiments have demonstrated that the catecholamine metabolites in the cerebral cortex were all significantly increased in the hyperthyroid versus the euthyroid rats.

Methods: A 55-years-old female presented an involuntary contraction of neck and was diagnosed with Cervical Dystonia, months later she has presented loss weight and 2 episodes of arrhytmia (atrial fibrillation). A thyroid function test confirmed she had hyperthyroidism, with an elevated serum thyroxine of 10,4 ng/dl (0,7- 1,5), suppressed thyroid-stimulating hormone < 0.05 mUI/l (0.36–3.24). At that time she was forwarded to a general clinic doctor but the patient has had complications with the treatment and worsening of symptons by the thyroid disorder, developing exophthalmia and a new involuntary movements in both hands characterized in our ambulatory as Choreoathetosis. New blood test has shown that TSH at this time was 0,00 mUI/ml.

Results: We have forwarded to the endocrinology ambulatory and she initiated the correct treatment to the Thyroid Disease. After that the choreoathetoid movements began to decrease. The patient is still been followed in our service.

Conclusions: We highlight the unique combination, first reported, of Cervical Dystonia and Choreoathetosis in a Hyperthyroidism patient. Furthermore, we emphasize the need for greater attention to thyroid function in those with involuntary movements aiming optimize clinical management.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/choreoathetosis-associated-with-cervical-dystonia-as-clinical-presentation-of-thyrotoxicosis-a-rare-condition/