CASE HISTORY – March 2019

Bulbar palsy. A rare manifestation of thyroid storm

Authors: Ivan Pertsev, Maire Lubi, Georgi Zjablov

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Abstract

Thyroid storm is an infrequent and severe endocrinologic emergency. If left undiagnosed or untreated, this condition inevitably progresses to multiorgan dysfunction and eventually to death. The majority of thyroid storm cases occur in patients with undiagnosed or inadequately treated Graves’
disease with some triggering event, but thyroid crisis may also develop in other thyrotoxic conditions and can in some cases have an iatrogenic cause. In rare instances thyroid storm, apart from its usual presentation, may manifest as thyrotoxic myopathy and polyneuropathy. In this article we publish a case of a79-year-old male who was hospitalized with classic presentation of thyroid storm and accompanying bulbar palsy of an unknown cause. He was diagnosed with Graves’ disease based on laboratory findings. Workup did not reveal any concomitant neurologic or muscular disease; his ENMG showed  a pattern of peripheral motor neuron injury. The  general condition of the patient improved and bulbar palsy resolved completely after 3 weeks of antithyroid treatment.