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Rare disease
CASE REPORT
Wernicke’s encephalopathy secondary to gestational hyperthyroidism
  1. Vishnu Vardhan Garla1,
  2. Licy Yanes-Cardozo2,
  3. Tauqeer Yousuf3,
  4. Shema Ahmad2
  1. 1Internal medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
  2. 2Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
  3. 3Mississippi Baptist Health System, Jackson, Mississippi, USA
  1. Correspondence to Vishnu Vardhan Garla, vishnu.garla{at}gmail.com

https://doi.org/10.1136/bcr-2017-221644

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    Background

    Wernicke’s encephalopathy is a neurological disorder secondary to the deficiency of vitamin B1 (thiamine). The classic symptoms consist of nystagmus, ophthalmoplegia, ataxia and mental status changes.1 Initially, this was described by Carl Wernicke in 1881 as acute haemorrhagic polioencephalitis.2

    Wernicke’s encephalopathy is mostly described in association with malnutrition and alcoholism.1 However, it has been increasingly being noted in various other settings. There is also evidence that this may be an underdiagnosed condition as several cases may not manifest the classical triad of symptoms. Prompt diagnosis and treatment are essential as any delay or undertreatment can result in irreversible complications.

    We report a case of gestational hyperthyroidism causing Wernicke’s encephalopathy. To our knowledge, there have been only four previous cases of gestational hyperthyroidism causing Wernicke’s encephalopathy in the literature.3–7

    Case presentation

    A 34-year-old G3P2 11-week 6-day-old pregnant female patient presented to the emergency department with a history of confusion, nausea and vomiting. Prior to this, she was admitted a month ago for hyperemesis. At that point, thyroid function tests showed a suppressed thyroid-stimulating hormone (TSH) of 0.01 (0.27–4.2 ng/dL) and high free thyroxine (FT4) of 3.88 (0.9–1.7 ng/dL). Thyroid-stimulating immunoglobulin and thyroid receptor antibody were negative ruling out Graves’ disease. She was diagnosed as having gestational hyperthyroidism and treated with hydration and antiemetics, no thionamides were given; her FT4 trended downwards and she was discharged.

    Since discharge, she continued to have vomiting, and also developed worsening of her mental status. Although she was prescribed prenatal vitamins, she was unable to take them secondary to persistent vomiting. She had a 30 lb weight loss in the last 1 month. Vitals on admission showed tachycardia of 134 beats/min and a temperature of 98.1. On examination, she was cachectic and had difficulty answering questions. No exophthalmos or thyromegaly was noted. Heart and lung examination was normal except …

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    Footnotes

    • Contributors VVG and LY-C were involved in writing the case description, formatting the images and writing the discussion section. SA and TY were involved in the literature search and editing of the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.