Thyrotoxicosis Associated with Guillain–Barré Syndrome: A Rare Autoimmune Overlap
https://doi.org/10.15605/jafes.041.S1
- Author:
Nur Asmak Abdullah
1
;
Rabeah Md Zuki
2
;
Mohamed Azlam Micdhadhu
3
Author Information
1. Internal Medicine Unit, Department of Medicine, Hospital Sultan Abdul Halim (HSAH)
2. Endocrinology Unit, Department of Medicine, Hospital Sultan Abdul Halim (HSAH)
3. Neurology Unit, Hospital Seberang Jaya
- Publication Type:Journal Article
- MeSH:
Thyrotoxicosis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):117-118
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:The coexistence of thyroid storm and Guillain–Barré
syndrome (GBS) is rare, with few reported cases. A shared
autoimmune mechanism has been suggested, although
the exact pathophysiology remains unclear. In severe
thyrotoxicosis, new neurological symptoms may be overlooked or attributed to metabolic causes, delaying diagnosis
and posing a diagnostic and therapeutic challenge. We
report a case of a 43-year-old female with Graves’ disease
complicated by thyroid storm and Acute Motor Axonal
Neuropathy (AMAN), a variant of GBS, highlighting the
importance of early recognition and multidisciplinary
management.
Case:A 43-year-old female with no prior medical illness
presented with fever, generalized weakness, fine tremors,
and 10 kg weight loss over 5 months. On arrival, she was
lethargic, febrile (40.2°C), and tachycardic (148 bpm),
consistent with thyroid storm by Burch–Wartofsky
criteria. She denied preceding diarrheal illness or upper
respiratory tract symptoms. The thyroid function test
showed markedly elevated free thyroxine 4 (>64.35 pmol/L)
and suppressed thyroid-stimulating hormone (TSH)
(<0.008 mIU/L). Subsequent testing revealed elevated TSH
receptor antibodies (>40 IU/L), confirming Graves’ disease.
Her course was complicated by anaphylactic shock with
transient cardiac arrest, followed by acute kidney injury and
respiratory failure requiring intensive care unit admission
and mechanical ventilation. Following extubation,
symmetrical limb weakness with generalized areflexia and
bilateral foot drop was observed. Nerve conduction studies
demonstrated a symmetrical axonal motor-predominant
polyneuropathy consistent with AMAN.
She received five sessions of plasma exchange and showed
marked neurological improvement, while thyroid and
renal function normalized at discharge.
Conclusion:This case highlights a rare and potentially life-threatening
association of thyroid storm and AMAN. Severe
thyrotoxicosis can precipitate atypical autoimmune
complications, underscoring the need for vigilance.
Clinicians should consider neurological evaluation in
patients with severe thyrotoxicosis presenting with newonset motor weakness.
- Full text:2026080509390038315EP_A175.pdf
