Acute Thyrotoxic Bulbar Myopathy with Encephalopathic Behaviour: An Uncommon Complication of Hyperthyroidism

Table 1

Hospital course prior to ICU transfer	Neurologic and cardiovascular symptoms
Day 1	Lethargy, uncontrolled tachycardia
Day 2	Left cervical dystonia with uncontrolled tachycardia and atrial fibrillation despite maximum AV nodal blockade.
Day 3	Disorientation and unintelligible speech
Day 4	Severe dysarthria, gegenhalten type rigidity in bilateral upper and lower extremities, decreased strength in proximal upper and lower extremities, hyperreflexia, clonus, and bilateral grasp reflexes
Day 5	Asterixis, agitation, right cervical dystonia with spontaneous resolution on the left, severe dysarthria, and worsening tachycardia
Day 6	Extreme lethargy, dysphagia, oropharyngeal pooling of secretions, tachypnea, and stridor