Objective: To emphasize the importance of thyroid dysfunction as one of the factors that could exacerbate Parkinson’s disease (PD) symptoms.

Background: Common endocrine disorder associated with PD is thyroid dysfunction. It may have an increased risk of developing as well as exacerbating PD symptoms, such as akinesia, tremor, rigidity, and on–off phenomena.[1,2] We present a case of delayed diagnosis of hyperthyroidism in Parkinson’s disease with aggravating symptoms.

Method: A case report.

Results: A 57-year-old woman presented with left-hand action tremors for five years. The tremor was first seen on the left side and then gradually extended to the other extremities. It was also worsened by activity or intense emotion. No other symptoms were found at that time, and no disturbance in daily activities. She was diagnosed with PD and then took levodopa and pramipexole. She did not continue the medication due to the side effect of palpitations.

In the last two years, she developed other symptoms, such as slow movements, short stepping gait, limb and trunk rigidity, and postural instability. There were also worsening tremors, hyposmia, sleep disturbance, loss of weight, and worsening heart palpitation. On the physical examinations, we found resting and postural tremors, bradykinesia, rigidity, also a positive retropulsion test.

The endocrine investigation then revealed hyperthyroidism with low thyroid stimulating hormone (TSH) level (<0.003 DIU/mL), high free T4 (2.07 ng/dL), and high thyroid stimulating hormone receptor antibody (TRAb). She was diagnosed with Grave’s Disease and has a notable improvement in her tremor with thiamazole and propranolol therapy. The parkinsonism symptoms were controlled with levodopa therapy.

Conclusion: The co-existence of Parkinson’s disease and hyperthyroidism can pose diagnostic and therapeutic challenges. The inclusion of hyperthyroidism in the differential diagnosis of worsening tremulous symptoms in PD is advisable, and there is a possibility of notable improvement of exaggerated tremor after the correction of hyperthyroidism. From other perspectives, hyperthyroidism may also serve as a contributing factor to the development of PD.

References: 1. Charoenngam N, Rittiphairoj T, Ponvilawan B, Prasongdee K. Thyroid Dysfunction and Risk of Parkinson’s Disease: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2022 May 4;13.
2. Schneider SA, Tschaidse L, Reisch N. Thyroid Disorders and Movement Disorders—A Systematic Review. Mov Disord Clin Pract. 2023 Feb 3;

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MDS Abstracts - https://www.mdsabstracts.org/abstract/delayed-diagnosis-of-hyperthyroidism-in-parkinsons-disease-patient-a-case-report/