TWO CASES OF GRAVES' DISEASE WITH SIGNS OF A PYRAMIDAL LESION. IMPROVEMENT IN NEUROLOGIC SIGNS DURING TREATMENT WITH ANTITHYROID DRUGS

Abstract

Two cases of Graves' disease with concomitant symptoms of pyramidal irritation are reported. Treatment with antithyroid drugs alleviated both the endocrine and the neurologic signs and symptoms. This is the main argument in favor of the neurologic disorder being of thyrotoxic origin. THIS report concerns 2 patients in whom signs of a pyramidal lesion appeared in the course of Graves' disease. The neurologic signs and symptoms disappeared almost entirely in association with improvement in the hyperthyroidism during treatment with antithyroid drugs. case 1 (No. 16,545). A 50-year-old woman was seen in June 1957 because of palpitation, nervousness, fatigue and loss of weight. She had difficulty in walking owing to weakness of the lower limbs. This condition had developed over a period of about four weeks. The patient was in the menopause and had had climacteric symptoms (hot flushes and tingling of the hands) for a year and a half. The mother and 2 cousins had goiter. Physical examination revealed typical Graves' disease, with exophthalmos, bilateral Graefe's sign, diffuse goiter, tachycardia (152 beats per minute, regular), eardiovascular instability, palpitation, and tremor of the fingers. Mentation and speech were normal. The only abnormality in the eranial nerves was an increased masseter reflex. Pupillary reflexes were normal. There was slight hypotonus in the upper limbs. Muscle volume was preserved, and strength was normal in all sectors. Tendon reflexes were exaggerated on both sides, and on the left there was an increase in the reflexogenic area for the supinator reflex. Hoffmann's sign could be elicited bilaterally. In the lower limbs there was moderate wasting of both quadriceps. Plummer's and Lahey's signs were present. Passive movement revealed hypotonus of the psoas, iliacus and quadriceps muscles;