PT - JOURNAL ARTICLE AU - Aparna Sharma AU - Nilofar Noor AU - Vatsla Dadhwal TI - Neurological manifestation in severe hypothyroidism in pregnancy AID - 10.1136/bcr-2020-238069 DP - 2020 Dec 01 TA - BMJ Case Reports PG - e238069 VI - 13 IP - 12 4099 - http://casereports.bmj.com/content/13/12/e238069.short 4100 - http://casereports.bmj.com/content/13/12/e238069.full SO - BMJ Case Reports2020 Dec 01; 13 AB - 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.