Thyroid Disorders and Movement Disorders-A Systematic Review

Abstract

Background: There is overlap between movement disorders and neuroendocrine abnormalities.

Objectives and methods: To provide a systematic review on the association of thyroid dysfunction and movement disorders. Thyroid physiological function and classical thyroid disorders highlighting typical and atypical manifestations including movement disorders, as well as diagnostic procedures, and treatments are discussed.

Results: Hypothyroidism may be associated with hypokinetic and hyperkinetic disorders. There is debate whether their concomitance reflects a causal link, is coincidence, or the result of one unmasking the other. Hypothyroidism-associated parkinsonism may resemble idiopathic Parkinson's disease. Hypothyroidism-associated hyperkinetic disorders mainly occur in the context of steroid-responsive encephalopathy with autoimmune thyroiditis, that is, Hashimoto disease, mostly manifesting with tremor, myoclonus, and ataxia present in 28-80%, 42-65% and 33-65% in larger series. Congenital hypothyroidism manifesting with movement disorders, mostly chorea and dystonia, due to Mendelian genetic disease are rare.Hyperthyroidism on the other hand mostly manifests with hyperkinetic movement disorders, typically tremor (present in three quarters of patients). Chorea (present in about 2% of hyperthyroid patients), dystonia, myoclonus, ataxia and paroxysmal movement disorders, as well as parkinsonism have also been reported, with correlation between movement intensity and thyroid hormone levels.On a group level, studies on the role of thyroid dysfunction as a risk factor for the development of PD remain non-conclusive.

Conclusions: In view of the treatability of movement disorders associated with thyroid disease, accurate diagnosis is important. The pathophysiology remains poorly understood. More detailed case documentation and systematic studies, along with experimental studies are needed.

Keywords: Allan‐Herndon‐Dudley syndrome; Grave's disease; Hashimoto encephalopathy; Hashimoto's thyroiditis; autoimmune thyroiditis; benign hereditary chorea; brain‐thyroid‐lung syndrome; chorea; dystonia; hyperthyroidism; hypothyroidism; myoclonus; parkinsonism; steroid‐responsive encephalopathy associated with autoimmune thyroiditis (SREAT); thyreoglobulin antibodies (TGAb); thyreoid peroxidase antibodies (TPOAb); thyroid disorder; tremor.

FIG. 1

Main antibodies associated with thyroid disease and their overlap (reproduced from ³ ). TPOAb, Anti‐thyroid peroxidase antibody; TGAb, Thyroglobulin antibodies, TSAb, THS receptor simulating antibody; TBAb, TSH receptor blocking antibody.