Case Report

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

Table 1


Hospital course prior to ICU transferNeurologic and cardiovascular symptoms

Day 1Lethargy, uncontrolled tachycardia
Day 2Left cervical dystonia with uncontrolled tachycardia and atrial fibrillation despite maximum AV nodal blockade.
Day 3Disorientation and unintelligible speech
Day 4Severe 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 5Asterixis, agitation, right cervical dystonia with spontaneous resolution on the left, severe dysarthria, and worsening tachycardia
Day 6Extreme lethargy, dysphagia, oropharyngeal pooling of secretions, tachypnea, and stridor