J Korean Endocr Soc.  2008 Oct;23(5):342-346. 10.3803/jkes.2008.23.5.342.

A Case of Graves' Disease Presenting with Chorea

• Ku CR
• Park HJ
• Hong SJ
• Shin DY
• Lee JH
• Chung MJ
• Cho MA
• Noh TW
• Lee BI
• Lee EJ

• KMID: 1479228
• DOI: http://doi.org/10.3803/jkes.2008.23.5.342

Abstract

Hyperthyroidism is invariably accompanied by nervous system dysfunction. Specifically, irritability, emotional lability, and hyperkinesia are the signs and symptoms most frequently observed. In rare instances, chorea and/or choreoathetosis are associated with hyperthyroidism. Full evaluation for the etiology of chorea is necessary prior to initiating treatment. We recently encountered a 42-year-old female who initially presented with hyperthyroidism and showed subsequent development of progressive generalized chorea. The patient was diagnosed with chorea secondary to Graves' disease after exclusion of other causes of chorea and improved after the initiation of pulse administration of intravenous methylprednisolone sodium succinate (Solu-medrol(R), 1000 mg for 5 days) and oral antithyroid medication. This treatment strategy resulted in the resolution of involuntary movements. The steroid administration was eventually tapered, and the patient has been maintained on antithyroid and steroid therapy with considerable success since the initiation of treatment.

Keyword

chorea; graves' disease; hyperthyroidism

MeSH Terms

Adult
Chorea
Dyskinesias
Female
Graves Disease
Humans
Hyperkinesis
Hyperthyroidism
Methylprednisolone Hemisuccinate
Nervous System
Methylprednisolone Hemisuccinate

Figure

• 

  Fig. 1 Serial changes in free T4 thyroid hormone levels (Unit: ng/dL). Axis X is the date that steroid tapering occurred. Axis Y is the level of free T4. Each of the dotted bars below axis X represents the steroid dose. On the day of admission, laboratory tests revealed free T4 levels of 3.77 ng/dL, T3 levels of 273 ng/dL, TSH levels of < 0.01 µIU/mL, and TBII at 51%. The final laboratory tests (September 21st, 2007) revealed normalization with free T4 levels of 1.04 µg/dL, T3 levels of 163 ng/m, TSH levels of 1.25 µIU/mL, and a TBII of 15%. Steroid administration was eventually tapered off to 5 mg daily and PTU has been maintained at 100 mg daily. The patient has been successfully managed with antithyroid and steroid therapy since the initiation of treatment, without recurrence of choreic movement.

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