Abstract 53: Acute thyrotoxic bulbar myopathy: An unusual presentation of hyperthyroidism

Background: Acute bulbar palsy manifested as thyroid storm is a rare presentation of hyperthyroidism. Aims and Objectives: We present a case of 22 year male presented with gradually progressive symmetrical weakness involving proximal muscles of both limbs since 1 year and new onset bulbar symptoms for last 15 days. It was associated with low grade intermittent fever, chronic diarrhea and significant weight loss. He was diagnosed as primary hyperthyroidism outside 6 months back but he discontinued medication since last 1 month. On presentation, he looked confused with staring look; skin was warm and moist with profuse sweating. Pulse rate was 140 beats per minute, regular; fine tremor was noted in both hands. Power was 3/5 in proximal muscles of both limbs with all reflexes diminished and flexor plantar. Results: On evaluation, FT4 was high 2.5 ng/dl, TSH was low 0.006 microIU/L, raised Anti TPO antibody (>1300 U/ml). Radio iodine uptake scan showed diffuse homogeneously increased tracer uptake in thyroid gland. CSF analysis, RNST, Anti cholinesterase antibody, NCS, EMG, and Neuroimaging were normal. He improved with antithyroid medication, beta blocker and steroid. Conclusions: Acute bulbar palsy is an uncommon but treatable complication of thyrotoxicosis that requires immediate intervention.