Choreic Movements as Manifestation of Hyperthyroidism in an Adolescent at the Onset of Graves’ Disease

Authors

  • Valeria Calcaterra Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy and Department of Pediatrics, “V. Buzzi” Children’s Hospital, Milan, Italy
  • Marco Burrone Department of Pediatrics, “V. Buzzi” Children’s Hospital, Milan, Italy and “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
  • Dario Dilillo Department of Pediatrics, “V. Buzzi” Children’s Hospital, Milan, Italy and “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
  • Gian Vincenzo Zuccotti Department of Pediatrics, “V. Buzzi” Children’s Hospital, Milan, Italy and “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, Milan, Italy

DOI:

https://doi.org/10.12974/2311-8687.2020.08.5

Keywords:

Chorea, Graves’ Disease, Hyperthyroidism, Thyroid.

Abstract

Objective; Nervous system dysfunction, including irritability, emotional lability and hyperkinesia are the signs and symptoms frequently observed in hyperthyroidism; chorea and/or choreoathetosis have also been reported in adults and rarely in pediatric age.

Case report; We described the case of a 12-year-old boy with bilateral choreiform movements of the arms at the onset of the Graves’ disease. The patient was treated with metimazole and chorea disappeared with euthyroidism.

Discussion; Hyperthyroidism is to be considered an unusual cause of chorea in childhood. Every child and adolescent with choreiform movements should be examined also for thyroid function. 

References

Léger J, Oliver I, Rodrigue D, Lambert AS, Coutant R. Graves' disease in children. Ann Endocrinol (Paris) 2018; 79(6): 647-55. https://doi.org/10.1016/j.ando.2018.08.001 DOI: https://doi.org/10.1016/j.ando.2018.08.001

Srinivasan S, Misra M. Hyperthyroidism in children. Pediatr Rev 2015; 36(6): 239-48. https://doi.org/10.1542/pir.36-6-239 DOI: https://doi.org/10.1542/pir.36.6.239

De Luca F, Alessi L, Bruno E, Cama V, Costanzo D, Genovese C, et al. Graves' disease in childhood: new epidemiological, pathophysiological and therapeutic insights. Minerva Pediatr 2016; 68(1): 66-9.

Park J, Kim JG, Park SP, Lee HW. Asymmetric chorea as presenting symptom in Graves' disease. Neurol Sci 2012; 33(2): 343-45. https://doi.org/10.1007/s10072-011-0679-0 DOI: https://doi.org/10.1007/s10072-011-0679-0

Sudo K, Tashiro K. Hyperthyroidism-associated chorea. Lancet 1998; 352(9123): 239. https://doi.org/10.1016/S0140-6736(05)77847-8 DOI: https://doi.org/10.1016/S0140-6736(05)77847-8

Cretel E, Amoura Z, Piette JC. Hyperthyroidism-associated chorea. Lancet 1998; 352(9123): 239. https://doi.org/10.1016/S0140-6736(05)77846-6 DOI: https://doi.org/10.1016/S0140-6736(05)77846-6

Arifi B, Gupta S, Sharma S, Daraboina A, Ahuja S. A Case Report of Chorea Associated with Hyperthyroidism. J Clin Diagn Res 2016; 10(2): PL01. https://doi.org/10.7860/JCDR/2016/17299.7277 DOI: https://doi.org/10.7860/JCDR/2016/17299.7277

Lucantoni C, Grottoli S, Moretti A. Chorea due to hyperthyroidism in old age. A case report. Acta Neurol 1994; 16(3): 129-33.

Willshaw ME, Atria A, Ferrer S. Hyperthyroidism and choreoathetosis. Rev Chil Pediatr 1986; 57(6): 573-74. https://doi.org/10.4067/S0370-41061986000600023 DOI: https://doi.org/10.4067/S0370-41061986000600023

Muthipeedika JM, Moosa A, Kumar A, Suchowersky O. Bilateral chorea-ballism associated with hyperthyroidism. Mov Disord 2005; 20(4): 512; author reply512. https://doi.org/10.1002/mds.20436 DOI: https://doi.org/10.1002/mds.20436

Ristić AJ, Svetel M, Dragasević N, Zarković M, Koprivsek K, Kostić VS. Bilateral chorea-ballism associated with hyperthyroidism. Mov Disord 2004; 19(8): 982-83. https://doi.org/10.1002/mds.20119 DOI: https://doi.org/10.1002/mds.20119

Shahar E, Shapiro MS, Shenkman L. Hyperthyroid-induced chorea. Case report and review of the literature. Isr J Med Sci 1988; 24(4-5): 264-66.

Clements MR, Hamilton DV, Siklos P. Choreoathetoid movements and thyrotoxicosis. J R Soc Med 1981; 74(10): 777. https://doi.org/10.1177/014107688107401017 DOI: https://doi.org/10.1177/014107688107401017

Fidler SM, O'Rourke RA, Buchsbaum HW. Choreoathetosis as a manifestation of thyrotoxicosis. Neurology 1971; 21(1): 55-7. https://doi.org/10.1212/WNL.21.1.55 DOI: https://doi.org/10.1212/WNL.21.1.55

Delwaide PJ, Schoenen J. Hyperthyroidism as a cause of persistent choreic movements. Acta Neurol Scand 1978; 58(5): 309-12. https://doi.org/10.1111/j.1600-0404.1978.tb02892.x DOI: https://doi.org/10.1111/j.1600-0404.1978.tb02892.x

Yu JH, Weng YM. Acute chorea as a presentation of Graves disease: case report and review. Am J Emerg Med 2009; 27(3): 369.e1-369.e3. https://doi.org/10.1016/j.ajem.2008.05.031 DOI: https://doi.org/10.1016/j.ajem.2008.05.031

Seeherunvong T, Diamantopoulos S, Berkovitz GD. A nine year old girl with thyrotoxicosis, ataxia, and chorea. Brain Dev 2007; 29(10): 660-61. https://doi.org/10.1016/j.braindev.2007.04.002 DOI: https://doi.org/10.1016/j.braindev.2007.04.002

Pozzan GB, Battistella PA, Rigon F, Zancan L, Casara GL, Pellegrino PA, et al. Hyperthyroid-induced chorea in an adolescent girl. Brain Dev 1992; 14(2): 126-27. https://doi.org/10.1016/S0387-7604(12)80102-1 DOI: https://doi.org/10.1016/S0387-7604(12)80102-1

Marks P, Anderson J, Vincent R. Choreo-athetosis with severe thyrotoxicosis. Postgrad Med J 1979; 55(649): 830- 31. https://doi.org/10.1136/pgmj.55.649.830 DOI: https://doi.org/10.1136/pgmj.55.649.830

Cardoso F, Seppi K, Mair KJ, Wenning GK, Poewe W. Seminar on choreas. Lancet Neurol 2006; 5(7): 589. https://doi.org/10.1016/S1474-4422(06)70494-X DOI: https://doi.org/10.1016/S1474-4422(06)70494-X

Punukollu M, Mushet N, Linney M, Hennessy C, Morton M. Neuropsychiatric manifestations of Sydenham's chorea: a systematic review. Dev Med Child Neurol 2016; 58(1): 16-28. https://doi.org/10.1111/dmcn.12786 DOI: https://doi.org/10.1111/dmcn.12786

Zijlmans JC. Vascular chorea in adults and children. Handb Clin Neurol 2011; 100: 261-70. https://doi.org/10.1016/B978-0-444-52014-2.00018-5 DOI: https://doi.org/10.1016/B978-0-444-52014-2.00018-5

Groothuis JR, Groothuis DR, Mukhopadhyay D, Grossman BJ, Altemeier WA. Lupus-associated chorea in childhood. Am J Dis Child 1977; 131(10): 1131-34. https://doi.org/10.1001/archpedi.1977.02120230077014 DOI: https://doi.org/10.1001/archpedi.1977.02120230077014

Lefter S, Corcoran L, McAuliffe E, Khan R, Burke L, Regan M, et al. Coeliac disease presenting with chorea. Pract Neurol 2020; 20(2): 144-47. https://doi.org/10.1136/practneurol-2019-002396 DOI: https://doi.org/10.1136/practneurol-2019-002396

Andrade C, Rocha H, Albuquerque A, Sá MJ. Gluten chorea. Clin Neurol Neurosurg. 2015; 138: 8-9. https://doi.org/10.1016/j.clineuro.2015.07.009 DOI: https://doi.org/10.1016/j.clineuro.2015.07.009

Ataya A, Harman E. Images in clinical medicine. Hemichoreoathetosis in neurosarcoidosis. N Engl J Med 2015; 372(21): e27. https://doi.org/10.1056/NEJMicm1407763 DOI: https://doi.org/10.1056/NEJMicm1407763

Roquer J. Neurological manifestations of hyperthyroidism]. Neurologia. 1992; 7(2): 65-72.

Klawans HI, Shenkar DM. Observations on dopaminergic nature of hyperthyroid chorea. J Neural Transm 1972, 33: 73-81. https://doi.org/10.1007/BF01244729 DOI: https://doi.org/10.1007/BF01244729

Hayashi R, Hashimoto T, Tako K, Efficacy of propranolol in hyperthyroid-induced chorea: a case report. Mov Disord 2003; 18(9): 1073-76. https://doi.org/10.1002/mds.10477 DOI: https://doi.org/10.1002/mds.10477

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Published

2020-06-06

How to Cite

Calcaterra, V., Burrone, M., Dilillo, D., & Zuccotti, G. V. (2020). Choreic Movements as Manifestation of Hyperthyroidism in an Adolescent at the Onset of Graves’ Disease. International Journal of Pediatrics and Child Health, 8, 30–32. https://doi.org/10.12974/2311-8687.2020.08.5

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