A Steady Cause of Unsteadiness: A Case of Thyroid-Associated Cerebellar Ataxia

Encephalopathy with autoimmune thyroid disease (EAATD) is mostly associated with Hashimoto's thyroiditis and has been uncommonly reported with Grave's disease. This case is aimed to report the association of EAATD with thyroid peroxidase (TPO) and thyroid-stimulating immunoglobulin (TSI) antibodies in Grave's disease. We report a 55-year old male who presented with thyrotoxicosis and cerebellar ataxia and was diagnosed with Grave's disease based on clinical and biochemical findings. The patient was managed with anti-thyroid medications with resolution of both thyrotoxicosis and cerebellar symptoms proving the hypothesis that patient's encephalopathy was autoimmune and related to his thyroid disease. High index of suspicion should be maintained for EAATD in patients presenting with neurological deficits with associated clinical and biochemical evidence of autoimmune thyroid disease.