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Reversible and unilateral corticospinal tract disease secondary to autoimmune free-T3-thyrotoxicosis
  1. Carlo Canepa1,
  2. Ramalingam Srinivasan2,
  3. Abdul Muhith3
  1. 1Stroke and Neurology, James Paget University Hospital, Norwich, UK
  2. 2Department of Endocrinology and Diabetes, James Paget University Hospital, Norwich, UK
  3. 3Department of Gastroenterology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
  1. Correspondence to Dr Carlo Canepa, Neurocanepa{at}


68-year-old female patient with no significant medical history presents with a 3-month history of progressive neurological symptoms, which began with left eye ptosis, blurred vision and non-painful jaw discomfort, followed by left spastic weakness and hyper-reflexia with positive Babinski and Hoffman signs. An elevated T3 level, a positive peroxidase and an antigraves antibody level led to an ultrasound, which confirmed a sub acute-chronic autoimmune thyroiditis. A nerve conduction studies/electromyogram showed normal motor and sensory velocity conduction with a small amplitude compound motor action potential, indicative of likely axonal damage. Following treatment with carbimazole, the neurological symptoms greatly improved. The authors concluded that the left pyramidal syndrome was secondary to autoimmune free T3-thyrotoxicosis.

  • Thyroid Disease
  • Neurology
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  • Contributors CC obtained the patient after seeing her as an inpatient with his junior AM. We then requested the pertinent investigations and obtained the antiperoxidase antibody and antigraves antibody. Once positive, we requested RS opinion and management. He then requested the USA of thyroid and started treatment with carbimazole. We all collaborated to obtain the pertinent papers to use as bibliography. CC made the main discussion with added comments from RS and AM and we all followed up the patient in clinic. We reached our conclusions together after meeting on a couple of occasions to discuss our findings and investigation results.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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