Overt Hypothyroidism Presenting with Isolated Lower Motor Neuron Facial Nerve Palsy
https://doi.org/10.15605/jafes.041.S1
- Author:
Murshidah Ainun Mukhtar
1
;
Rabeah Md Zuki
2
;
Wei Chin Mow
3
;
Nurul Farehah Mohd Nazri
3
Author Information
1. Medical Unit, Hospital Sik
2. Medical Department, Hospital Sultanah Bahiyah
3. Medical Department, Hospital Sultan Abdul Halim
- Publication Type:Journal Article
- MeSH:
Facial Nerve;
Hypothyroidism;
Motor Neurons;
Paralysis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):114-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Cranial nerve palsies have been reported in patients with
uncontrolled hypothyroidism. We describe a case of overt
hypothyroidism due to treatment disruption following
radioiodine therapy, presented with a unilateral lower
motor neuron seventh cranial nerve palsy.
Case:A 32-year-old female presented with hypertension,
dyslipidemia, class III obesity, and Graves’ disease post
radioiodine therapy. She had stable thyroid function test
with levothyroxine replacement post radioiodine. She
presented with a 3-day history of right-sided facial droop
associated with lethargy, weight gain, and constipation.
She reported inadequate levothyroxine supply due to
2-month lapses in follow-up.
On examination, there was a right-sided lower motor
neuron 7th cranial nerve palsy with delayed ankle reflexes.
No additional neurological deficits, goiter, cutaneous
rashes, or vesicular lesions were noted. There was no
preceding viral illness or otologic symptoms.
Thyroid function tests showed overt hypothyroidism with
thyroid-stimulating hormone 38 mIU/L, free thyroxine <5.4
pmol/L with a deranged lipid profile (total cholesterol: 8.8
mmol/L, low-density lipoprotein: 5.72 mmol/L, triglyceride:
1.77 mmol/L). Renal and liver function tests were within
normal limits, with no leukocytosis. Neuroimaging of the
brain was unremarkable.
She was commenced on a short course of high-dose prednisolone, with no improvement in symptoms. Levothyroxine
replacement therapy initiated led to progressive restoration
of thyroid function, accompanied by symptom recovery.
Conclusion:Isolated lower motor 7th nerve palsy has been reported as
a manifestation of hypothyroidism. This case underscores
the importance of early recognition to enable timely and
appropriate management, as patients with hypothyroidisminduced isolated seventh nerve palsy demonstrate marked
recovery with adequate levothyroxine replacement.
- Full text:2026080508542196716EP_A169.pdf
