Subclinical hypothyroidism presenting with gait abnormality

Subclinical thyroid disease is a common disorder, particularly in middle-aged and elderly individuals. Some patients with manifest hypothyroidism complain of unsteadiness of gait. The management of subclinical hypothyroidism is controversial. A 61-year-old man presented with a mild gait abnormality. He walked unsteadily on a broad base. Examination revealed a slight cerebellar ataxic gait. Laboratory evaluation showed elevated levels of thyroid-stimulating hormone. Serum free thyroxine was normal and thyroglobulin antibodies were present. Computer tomography of the patient's head was normal, as were other investigations. The patient responded rapidly to thyroxin treatment with resolution of the gait disturbance. A laboratory evaluation of thyroid function should be performed in similar cases, and treatment should be initiated when called for. Subclinical hypothyroidism can present as a cerebellar ataxic gait.