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Manipal Journal of Medical Sciences

Abstract

A 45-year-old gentleman, non-diabetic, normotensive, non-alcoholic and non-smoker presented with the complaints of insidious onset, progressive imbalance while walking, with occasional falls for the past six to eight months. The patient had no other complaints. He had exaggerated reflexes and loss of vibration sense. He also had wide based ataxic gait, with inability to perform fine coordinated actions. He had associated nystagmus. MRI brain suggested cerebellar atrophy. The thyroid profile was TSH- 176.9 mIU/l, FT3- 0.963 pmol/L, FT4- 0.023 pmol/L and antibodies were negative. All other parameters like complete blood count, renal and hepatic function tests, peripheral smear, vitamin B12, folate levels, ultrasonogram abdomen and nerve conduction velocity were within normal range. We present a case of cerebellar atrophy in a patient of hypothyroidism with no autoimmune condition or antibody detected. This is a rare presentation and the exact mechanism behind this occurrence is unknown. This case reveals that the possible mechanism behind ataxia in hypothyroidism may be cerebellar atrophy. And there is an unknown mechanism for the cerebellar atrophy different from that known for autoimmune conditions and Hashimoto’s thyroiditis.

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