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JAMA Neurology Clinical Challenge
March 9, 2020

Spasms and Myoclonus in a Young Woman With Hashimoto Thyroiditis

Author Affiliations
  • 1Department of Neurology, Shanghai Ruijin Hospital, Affiliated Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
JAMA Neurol. 2020;77(5):650-651. doi:10.1001/jamaneurol.2020.0175

A 39-year-old woman presented to the emergency department with a 3-week history of worsening spasms in her axial and lower limb muscles and new-onset urinary retention. Sudden episodes of painful involuntary spasms first appeared in her abdominal muscles 2 weeks after a cold. Soon after, spasms spread to all of her axial muscles and both lower limbs. These paroxysmal episodes lasted a few seconds, occurred up to 20 times a day, and were exacerbated by external stimuli. There was no impairment of consciousness during the attacks. A review of her previous records revealed a diagnosis of Hashimoto thyroiditis 1 month earlier. She had no history of tobacco, alcohol, or drug use.

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    1 Comment for this article
    Hashimoto's Encephalopathy (HE)
    Hassan Alayafi, FRCPC | King Abdulaziz Medical City-Riyadh
    i think this patient has Hashimoto's encephalopathy (HE) which usually presents with all the features mentioned, and responds to steroids which this patient did not receive. O did not see the EEG done for her to confirm epileptic myoclonus which is also common in Hashimoto's encephalopathy. Elevated thyroid antibodies support the diagnosis. The combination of elevated thyroid antibodies, encephalopathy, and response to steroids completes the diagnosis.