Objective:

To describe the spectrum of movement disorders in patients with positive anti-thyroid antibodies (ATA+).

Background:

Autoimmune thyroid diseases (AITD), including Hashimoto’s thyroiditis (HT) and Graves’ disease (GD), have well-reported neurological manifestations, including steroid-responsive encephalopathy, seizures, and cognitive changes. The association of movement disorders with AITD has been sparsely described and is mainly limited to myoclonus, ataxia, and tremors. We aim to characterize spectrum of movement disorders in patients with ATA+.   

Design/Methods:

In this retrospective study, we reviewed charts of 1,300 patients from the UConn Health neurology clinic (2018-2024), 320 of whom were ATA+. A final cohort of 40 patients with well described movement disorders were included for review. Data collected included patient demographics, antibody work-up, imaging conducted, and treatment with outcomes. Descriptive statistical analysis was utilized with confidence intervals (CI) and interquartile ranges.

Results:

The mean age of the cohort was 68 years (95% CI: 63-72), with 68% female. Dystonia was the most prevalent movement disorder (65%, n=26), followed by tremors (35%, n=14) and parkinsonism (25%, n=10). The average duration of symptoms before diagnosis was 4 years (95% CI: 3-5). In 58% of patients, the movement disorder manifested before thyroid antibodies were detected, with 79% being euthyroid at the time of presentation. Elevated anti-TPO levels were found in 92.5%, anti-TG in 50%, and anti-TSI in 7.5% of patients. CSF testing was performed in 5 patients, and CSF ATA were not tested. Additional serum antibodies, including GAD-65 Ab, were positive in 9 out of 11 patients tested. Among those treated with immunosuppressive therapies (n=8), 62.5% (n=5) showed clinical improvement.

Conclusions:

Our study builds on previously reported cases of dystonia in AITD, highlighting its higher frequency than previously recognized. Immunosuppressive treatments are sparingly utilized and can result in clinical improvement.  Further studies are needed to elucidate the causality and underlying mechanism for movement disorders with AITD.