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Just Another Case of Acute Stroke?

  • Marvin Wei Jie Chua
    Correspondence
    Requests for reprints should be addressed to Marvin Wei Jie Chua, Endocrinology Service, Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886.
    Affiliations
    Consultant, Endocrinology Service, Department of General Medicine, Sengkang General Hospital, Singapore
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Published:October 31, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.10.015
      A 45-year-old male with a history of hyperlipidemia presented with acute onset of slurred speech for 2 days. There were no other neurological symptoms such as facial or limb weakness or numbness. The initial impression was that of an acute stroke; however, urgent computed tomography (CT) scan of the brain was normal. Neurological examination was unremarkable, and the patient's voice was deep and hoarse sounding rather than being objectively slurred. On revisiting the history, the patient had symptoms of cold intolerance, lethargy, and weight gain for the last few months. There was no palpable goiter or vitiligo. Investigations showed primary hypothyroidism and elevated anti thyroid peroxidase antibodies (Table), consistent with newly diagnosed hypothyroidism secondary to Hashimoto thyroiditis. There were no features of myxedema coma; the patient was hemodynamically stable and was alert with no hypothermia. The patient was started on thyroxine 100 mcg daily with complete resolution of dysarthria over the next 2 days. On reviewing the medical records, it was noted that he had sought medical attention several times over the last 9 months for constipation; however, hypothyroidism was not diagnosed until the current admission.
      TableThyroid Function and Thyroid Antibodies at the Time of Initial Assessment
      Case 1 Case 2 Reference range
      fT4 (pmol/L) <3.0 <1.3 12.7-20.3
      TSH (mIU/L) 90.76 131 0.701-4.28
      Thyroid peroxidase antibodies (IU/mL) 13,660 N/A <9.0
      fT4 = free thyroxine; TSH = thyroid-stimulating hormone.
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