Abstract 90: Graves disease and parkinsonism: Is there a link?

Background: Symptoms of Parkinsons Disease can be easily overlooked in a patient with Graves disease. We report a case of Graves's disease whose tremors persisted despite adequate therapy with beta blockers and anti-thyroid drugs. Case Report: A sixty-five-year-old gentleman was diagnosed with Graves's disease three years ago. He was started on carbimazole, optimal doses. At the same time, the patient had slowness of movements, short stepping gait, and rigidity of limbs. The patient was diagnosed with Parkinsonism. The patient was started on optimal doses of dopaminergic drugs and was lost to follow up. The patient presented in October 2021, with weight loss, palpitations, diarrhoea, excess sweating, fine tremors of hands, anxiety and irritability, altered mental status, muscle stiffness which worsened over 4 weeks. The work up was negative for autoimmune Parkinsonism. Patient had stopped all the medications for Graves's disease and also dopaminergic drugs. Optimisation of carbimazole dose and dopaminergic drugs was done; patient is currently doing well and on regular follow up. Conclusion: This case report highlights the coexistence of Graves and Parkinsonism and importance of distinguishing immune mediated from degenerative Parkinsonism that can coexist in the presence of Graves which is an autoimmune disorder.