Endocrine Abstracts

Background: Graves’ disease is medical condintion requiring early diagnosis and urgent management, which can be challenging due to diverse clinical presentations. The presence of muscle paresis is rare.

Case Presentation: We report a 38-year-old female who presented with muscle paresis, urine and fecal incontinence, because of thyrotoxicosis due to Graves’ disease. Clinical manifestation: general weakness, body tremor, tachycardia, palpitations, leg muscle weakness, urinary and fecal incontinence, sweating, weight loss, diarrhea.

Illness history: symptoms of the disease manifestated during the COVID-19 pandemic (March the 2020). As the complaints became more prominent, the patient turned to local hospital Emergency department, thyrotoxicosis was diagnosed (TSH - 0.0 mU/l), treatment with thiamazole 5 mg 3 times/day was prescribed (after a few weeks to reduce to 2 tablets). The patient’s well-being improved, but after reducing to 2 tablets, the mentioned complaints reappeared. In June 2020, patient applied to outpatient department to endocrinologist, due to whole body tremor, leg muscle paresis (walking like having cerebral palsy), expressed tachycardia (HR 140 bpm), urinary and fecal incontinence. Patient was reffered and hospitalized to LHSU, Department of Endocrinology.

Investigations: Table No 1.

Ultrasound: Graves’ disease.

Thyroid scintigraphy: The total concentration of technetium in the thyroid gland is up to 47.4% (the norm is up to 2.0%). Image of a hyperfunctioning thyroid gland.

Treatment: Thiamazole 40 mg/d, Propranolol 40 mgx3, Prednisolone treatment was given. After euthyroid was reached, total thyroidectomy was performed (Feb 2021) and Levothyroxine 100 mg x1 p/os was prescribed. Patient was referred to an endocrinologist consultation after 1.5 months. Patient had a good clinical recovery following the treatment of thyrotoxicosis and postoperative hypothyrosis: the symptoms of Graves’ disease, muscle paresis, urinary and fecal incontinence regressed. Women became pregnant and delivered healthy newborn in December 2022.

Conclusions: Muscle paresis with urinary and fecal incontinence can be a rare manifestation of Graves’ disease, and should be considered in the differential diagnosis when other clinical features of thyrotoxicosis are present.