Endocrine Abstracts

Introduction: Parkinson’s disease is considered as a second most common neurodegenerative disorder but rarely associated with the Graves’ disease.

Case report: A 44-year-old female diagnosed as Graves’ disease having classical features of hyperthyroidism i.e. tremors of hands, palpitations, weight loss despite of good appetite and biochemical evidence of thyroid function tests (TFTs) i.e. raised free T4, low TSH and positive antibodies. She was given carbimazole for twelve months and then stopped with a warning of disease relapse. She remained symptomatic and treatment free for about one and a half year, then reported back with similar presentation and investigations were in favour of hyperthyroidism. She was offered a radioactive iodine treatment but given a risk to her child, she opted for a medical treatment. After having carbimazole for the next two years, she had a radioactive iodine treatment which resulted in the hypothyroidism, therefore, started on levothyroxine. Her levothyroxine was titrated and despite of her tremors, the rest of her symptoms subsided. Hence, she was given a trial of propranolol. She presented back to the clinic with tiredness and tremors. The TFTs showed TSH 19.14, fT4 23.3 (slightly above then normal). It showed that either there is an issue with the intermittent compliance or it could be there is interference antibodies. It was decided to repeat her TFTs using different assay.

Management: There were no changes made with regards to her medications. In the meantime, she was referred to the movement disorder team and found to have tremors which, at that time, were more obvious in the left arm along with a degree of some stiffness and bradykinesia. Therefore, DaT scan, copper and autoimmune studies were arranged. The results of her DaT scan consistent with idiopathic Parkinson’s disease. She was then reviewed by the Neurologist and started on anti-Parkinson’s medications and she noticed a significant symptomatic improvement.

Conclusion/learning points: Parkinson’s disease is a rare condition in young age group but, it should be considered in patients having non-resolving tremors, who had radioactive treatment for Graves’ disease and biochemically hypothyroid.