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Year : 2013  |  Volume : 17  |  Issue : 9  |  Page : 706


Date of Web Publication24-Dec-2013

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How to cite this article:
. Abstract. Indian J Endocr Metab 2013;17, Suppl S3:706

How to cite this URL:
. Abstract. Indian J Endocr Metab [serial online] 2013 [cited 2021 Jun 21];17, Suppl S3:706. Available from: https://www.ijem.in/text.asp?2013/17/9/706/123640

Bone and Parathyroid

Role of parathyroid hormone estimation in needle washing of parathyroid aspiration biopsy in localizing 99mtc-sestamibi negative primary hyperparathyroidism: Diagnostic implications and treatment outcomes

P. P. Chakraborty, Deep Dutta, Indira Maisnam, Rana Bhattacharjee, Ajitesh Roy, Sujoy Ghosh, Satinath Mukhopadhyay, Subhankar Chowdhury

Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, West Bengal, India

Corresponding Author: Dr. Sujoy Ghosh, Department of Endocrinology, IPGME&R, Kolkata, India. Email: [email protected]

Introduction: Hashimoto's encephalopathy is a steroid responsive encephalopathy associated with elevated concentration of antithyroid antibodies. The patients are usually euthyroid or hypothyroid. A wide array of clinical features has been reported till date. The pleomorphic manifestations may be behavioral or cognitive changes, myoclonus, pyramidal tract dysfunction, coma with relapsing, and pogressive course. The diagnosis is often overlooked at presentation given that this is a treatable disease. Description of Case: A 32-year-old male nondiabetic, nonhypertensive, nonalcoholic, and nonsmoker presented to us with sudden onset right sided hemiparesis and deviation of angle of mouth to left. This episode was preceeded by hoarseness of voice and difficulty in swallowing for 1 week. On examination patient was confused with slurred speech. There was right sided hemiparesis, power 3/5 in right upper and lower limb, exaggerated deep tendon reflex in all four limbs, extensor plantar response in right side along with lower motor neuron type palsy of right 7 th , 9 th , 10 th , and 8 th cranial nerve palsy. All routine examinations were normal including magnetic resonance imaging (MRI) of brain, electroencephalogram (EEG), and cerebrospinal fluid (CSF) study. But anti-thyroid peroxidase (TPO) was high (>1,300 U/L) with normal serum free thyroxine (FT4) and thyroid stimulating hormone (TSH). Ultrasonography (USG) revealed heterogenous thyroid and fine needle aspiration cytology (FNAC) showed lymphocytic autoimmune thyroiditis. We started steroid and in follow up patient experienced significant improvement. Discussion: Hashimoto's encephalopathy is an unusal neurological disorder with myriad of clinical features. Elevated serum antithyroid antibodies remains an essential characteristics of diagnosis. The pathogenic role of antbodies remains obscure. Conclusion: This is a first reported case of multiple cranial nerve involvement in a case of Hashimoto's encephalopathy. Henceforth, this presentation if kept in mind might help in instituting correct and early treatment.

Key words: FNA_PTH estimation, hyperparathyroidism


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