Endocrine Abstracts

51 y/o female with past medical history of migraine headache, brought to UR because of hypoactivity, generalized weakness, confusion, lack of balance and dysarthria since one day of evolution. No medications. No Habits. Past history: negative for hypertension, cardiac disease or dyslipidemia. Physical examination: normal vital signs and weight. Alert, awake, and oriented only in person. Palpable nontender left thyroid lobe. Bilateral hyperreflexia.

Labs: CBC, CMP, toxicology, urinalysis, ANA screen, RPR, and Anti-TPO: negative. Sed rate: 40 mmh TSH: 0.159 mIU/mL. TSI: negative. Anti-Thyroglobulin Antibody: positive. Anticardiolipin: negative.

CT scan of head: bilateral basal ganglia infarcts.

24 hours RAIU: 0.4%. Thyroid scan: thyroiditis.

Thyroid Ultrasound: small bilateral nodules. LP: negative. EEG: diffuse cortical dysfunction as seen in encephalophathy states. ACEI, statin and asa were started. Echocardiogram and carotid Doppler: negative. She was discharged after moderate clinical improvement.

Brain SPECT: negative.

MRI/MRA: Vasculitis cannot be excluded.

Hyperthyroidism is associated with atrial fibrillation and cardioembolic stroke. In thyrotoxic patients without cardiac arrhythmia, only 7 cases of acute cerebrovascular ischemic disease have been identified. Hyperthyroidism may be associated with cerebrovascular thrombosis (CVT), Moya-moya disease, antiphospholipid syndrome (APS), giant cell arteritis (GCA). The mechanism contributing to the association between hyperthyroidism and stroke are not fully understood. Possible explanations are: inflammatory factors and metabolic changes, leading to increases in carotid artery intima-medial thickening.

CVT is a very uncommon disease associated with several causes and risk factors, such as inherited thrombophilia, oral contraceptives, pregnancy, and puerperium. APS is a combination of arterial or venous thrombosis, recurrent fetal loss, and lupus anticoagulant or anticardiolipin antibodies. GCA is a chronic vasculitis among individuals >50 years of age. Moyamoya is a rare cerebrovascular disorder characterized by bilateral stenosis of the internal carotid which has been ruled-out in view of the MRI findings.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector