Year : 2017 | Volume
: 7 | Issue : 2 | Page : 37--39
Case series reporting hypothyroidism induced dysarthria : An unusual entity
Navgeet Mathur1, Medha Mathur2,
1 Department of General Medicine, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, India
2 Department of Community Medicine, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, India
Dr. Medha Mathur
Department of Community Medicine, Pacific Institute of Medical Sciences, Umarda, Udaipur - 313 015, Rajasthan
Hypothyroidism is a common endocrinal disorder which may present as an unusual presentation like dysarthria. Knowledge about unusual presentations in hypothyroidism may help to make correct diagnosis and treatment. This case series includes two cases of hypothyroidism-induced dysarthria. Both cases were misdiagnosed on previous medical consultations. Complete recovery was achieved after correct diagnosis and thyroxin replacement.
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Mathur N, Mathur M. Case series reporting hypothyroidism induced dysarthria : An unusual entity.J Laryngol Voice 2017;7:37-39
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Mathur N, Mathur M. Case series reporting hypothyroidism induced dysarthria : An unusual entity. J Laryngol Voice [serial online] 2017 [cited 2019 Jul 19 ];7:37-39
Available from: http://www.laryngologyandvoice.org/text.asp?2017/7/2/37/242237
Hypothyroidism may present with a variety of clinical features. Common presenting features are fatigue, lethargy, weight gain, constipation, dry-scaly skin, hair loss, menstruation irregularity, cold intolerance, and edema. Dysarthria is defined as poor articulation of speech. Hypothyroidism may present as dysarthria, an unusual presentation of the disease. The possible pathophysiology of dysarthria in hypothyroidism can be explained by edematous swelling of laryngeal and hypopharyngeal structures with macroglossia due to thickening of the epithelial tissue., Complete recovery may be possible in response to thyroxin replacement. This case series highlights the fact that hypothyroidism may be the underlying cause of dysarthria and there is high possibility of misdiagnosis due to lack of general awareness about this entity among health-care givers.
The first case was an 18-year old Hindu male resident of Tonk district, Rajasthan, India. He was a student and presented in 2014 with a complaint of slurred speech for 2 months. The patient was apparently asymptomatic 2 months back; after which he developed gradually progressive slurring of speech. Initially, he had slurring for only few words in a sentence, and after 15 days, he had complete slurring of speech with impaired fluency with multiple interruptions while speaking. Often, making multiple attempts to verbalize words correctly and had difficulty to speak in a flow.
He first consulted the neurology department of a health facility. where he was examined and investigated. Routine investigations such as complete blood count, erythrocyte sedimentation rate (ESR), blood sugar, and renal-liver function along with magnetic resonance imaging brain were done. We reviewed the investigations and found them to be normal. He was referred to ENT department for further management. After further evaluation by ENT department, he was referred to a speech therapist for speech therapy. He was undergoing speech therapy for a duration of 1½ months, but he did not get any significant relief. The patient came to medicine department accidentally as he wanted to investigate his blood group which was required to be filled in a driving license form.
A detailed history was taken after the patient discussed his compliant. There was no history of fever, difficulty in swallowing, drooping of eyelids, loss of consciousness, altered behavior, limb weakness, vomiting, diarrhea, constipation, shortness of breath, palpitation, blurring of vision, hearing impairment, and trauma. He did not have any other complaints. Only after the leading question had been asked about weight gain or loss, he admitted that he was lean and thin 3 months back and he gained weight thereafter; however, he assumed this was normal as he was weaker before and became healthy now, so he did not discuss about weight gain as a complaint in any of the previous medical consultation. Due to the history of weight gain, hypothyroidism was considered as one of the differential diagnoses.
There was no significant past, family, and drug history. The patient was a vegetarian, nonalcoholic, and nonsmoker. The patient had normal milestones of development during his life. On general physical examination, no significant abnormality was found. Vitals were within normal limits. On examination of the nervous system, no abnormality was found other than slurring of speech. Examinations of other systems were also found to be normal. Examination done by an otorhinolaryngologist and documents from previous consultations were not suggestive of any laryngeal or local structural abnormality.
Routine investigations such as hemoglobin, total leukocytes count, platelet count, ESR, peripheral blood film, renal-liver function test, serum electrolytes, serum protein, electrocardiogram (ECG), chest X-ray, and ultrasonography of the abdomen were found within normal limits. Thyroid profile was suggestive of hypothyroidism as T3, T4, and TSH were 0.2 ng/ml, 3.0 mcg/dl, and 20 μIU/ml, respectively. Other investigations such as VDRL, lipid profile, anti-TPO antibodies, HIV assay, HBsAg, anti-HCV antibodies, and ultrasonography of the thyroid gland were found to be within normal limits.
Diagnosis of hypothyroid-induced dysarthria was made. The patient was treated with tablet thyroxin 75 mcg once daily. The patient was a villager and used to take unbranded salt. The patient was advised to consume only iodized salt of good quality. On regular follow-up, dysarthria was completely resolved by medication in 1½-month duration without any speech therapy. Thyroid profile was also normalized in response to thyroxin replacement. There was no further weight gain. The patient was advised to continue the same medication further with regular follow-up.
The second case was a 54-year old Hindu female, a resident of Udaipur, Rajasthan, India. She presented in 2017 with a complaint of gradually progressive slurring of speech for the last 1 year. She underwent multiple consultations at various centers, with no relief. There was no significant past, personal, family, menstruation, obstetrics, and drug history. On general physical examination, dry-scaly skin, dry easily pluckable hairs, and madarosis were present. Vitals were within normal limits. No abnormality was found in neurological examination, except slurring of speech. Examination of other systems was also normal. Examination done by an otorhinolaryngologist and documents from previous consultation were not suggestive of any laryngeal or local structural abnormality.
The patient was investigated. Routine investigations such as hemoglobin, total leukocytes count, platelet count, blood sugar, renal-liver function test, serum protein, serum electrolytes, and urine routine were normal. No significant abnormality was found on ECG, chest X-ray, and ultrasonography of abdomen. Thyroid profile was suggestive of hypothyroidism as T3, T4, and TSH were 0.4 ng/ml, 2.0 mcg/dl, and 28 μIU/ml, respectively. Other investigations such as VDRL, lipid profile, anti-TPO antibodies, HIV assay, HBsAg, anti-HCV antibodies, and ultrasonography of the thyroid gland were found to be within normal limits. Contrast-enhanced computed tomography of the head was found normal.
The patient was treated with tablet thyroxin 100 mcg once a day. On regular treatment and follow-up, the patient recovered well after 2 months of medication and thyroid profile was normalized in response to treatment. The patient was advised to continue the same medication further with regular follow-up.
Hypothyroidism may have a variety of presentation. Hypothyroidism-induced dysarthria is an uncommon entity. In case of dysarthria where usual causes have been ruled out, hypothyroidism should be suspected investigated. Both the cases were misdiagnosed on multiple previous consultations. Meticulous history always plays a key role in reaching a diagnosis. In cases of dysarthria, hypothyroidism should be kept as one of the differential diagnoses even in male patients despite the fact that hypothyroidism is more common in females. There are only few case reports reporting hypothyroidism-induced dysarthria.,, Complete recovery can be possible by correct diagnosis and thyroxin replacement. General awareness is needed in healthcare professionals about this entity.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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