%0 Journal Article %A Aparna Sharma %A Nilofar Noor %A Vatsla Dadhwal %T Neurological manifestation in severe hypothyroidism in pregnancy %D 2020 %R 10.1136/bcr-2020-238069 %J BMJ Case Reports %P e238069 %V 13 %N 12 %X Neurological manifestations of hypothyroidism include peripheral neuropathy and pituitary hyperplasia. However, these associations are rarely encountered during pregnancy. We report a case of a known hypothyroid with very high thyroid stimulating hormone (TSH) values (512 μIU/mL) in the second trimester. At 24 weeks she developed facial palsy and pituitary hyperplasia which responded to a combination of steroids and thyroxine. She had caesarean delivery at 35 weeks and 3 days gestation in view of pre-eclampsia with severe features and was discharged on oral antihypertensives and thyroxine. On follow-up at 5 months, TSH normalised and pituitary hyperplasia showed a greater than 50% reduction in size. To our knowledge, this is the first reported case of facial palsy and pituitary hyperplasia associated with hypothyroidism during pregnancy. %U https://casereports.bmj.com/content/bmjcr/13/12/e238069.full.pdf