Acute parkinsonism in a patient with myxedema crisis: A case report

Gupta,Rajat; Chaudhary,Shakun; Sood,Vivek; Chauhan,Narvir Singh; Chauhan,Nidhi; Kapoor,Dhiraj

doi:10.3892/mi.2024.173

September-October 2024 Volume 4 Issue 5

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September-October 2024 Volume 4 Issue 5

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Case Report Open Access

Acute parkinsonism in a patient with myxedema crisis: A case report

Authors:
- Rajat Gupta
- Shakun Chaudhary
- Vivek Sood
- Narvir Singh Chauhan
- Nidhi Chauhan
- Dhiraj Kapoor
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Affiliations: Department of Medicine, Dr Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, Himachal Pradesh 176001, India, Department of Endocrinology, Dr Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, Himachal Pradesh 176001, India, Department of Radiology, Dr Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, Himachal Pradesh 176001, India

Copyright: © Gupta et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
Article Number: 49
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Published online on: July 2, 2024

https://doi.org/10.3892/mi.2024.173
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Abstract

Both myxedema crisis and Sheehan's syndrome are uncommon conditions. The first‑time presentation as myxedema crisis is rare in Sheehan's syndrome. The present study describes the case of a 31‑year‑old female patient who presented with altered sensorium in the emergency room. The patient was not a known case of hypothyroidism, but had a history of secondary amenorrhea and lactation failure following the birth of a child 11 years prior. Upon evaluation, she was found to have hypothermia, hypotension, the delayed relaxation of deep tendon reflexes, bradycardia and hyponatremia, which led to the suspicion of myxedema crisis. Her thyroid function tests were suggestive of secondary hypothyroidism and her pituitary hormonal profile revealed panhypopituitarism. The patient was managed on the lines of myxedema crisis with oral levothyroxine, hydrocortisone infusion, antibiotics and rewarming. Her clinical and biochemical parameters exhibited an improvement; however, her altered sensorium persisted. A repeat neurological examination revealed cogwheel rigidity with paraparesis, which led to the clinical suspicion of acute parkinsonism. Magnetic resonance imaging of the sella and brain was suggestive of an empty sella and extrapontine myelinolysis, substantiating the diagnosis of Sheehan's syndrome with acute parkinsonism. The patient was commenced on levodopa‑carbidopa following which there was an improvement in symptoms. The patient improved over the ensuing 6 months and can now perform all household activities. On the whole, the present study indicates that the early suspicion of myxedema crisis, prompt treatment and the recognition of additional aetiology for persistent altered sensorium can result in a successful outcome for the patient.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Acute parkinsonism in a patient with myxedema crisis: A case report

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