Bilateral Basal Ganglia Calcifications and Graves’ Disease in a Young Patient – A Very Rare Association

Basal ganglia calcification is a radiological finding which can be primary or secondary to metabolic, infectious, or neurologic diseases. It is also considered physiological in people over 50 years, however, it is pathological in the younger population.

Case Description:

A 27-year-old Filipino man with no known chronic illnesses presented to the Emergency Department (ED) complaining of acute legs weakness started 2 hours prior to coming to ED. He also had some weakness in his arms but was less in severity. The patient denied any pain or numbness. He mentioned a history of weight loss of 5kg during the past month. Vital signs were normal apart from tachycardia 117/minute. Physical examination revealed muscle power 4/5 in both upper limbs, and 3/5 in both lower limbs, and diffuse goiter. ECG demonstrated sinus tachycardia. Given the acute onset of the weakness, head computed tomography was done to rule out stroke, however, it showed Bilateral basal ganglia and dentate nuclei calcifications. Blood tests were remarkable for high FT4 >100 mIU/L (11.0-23.3), low TSH < 0.01 mIU/L (0.30-4.20), low potassium level =3 mmol/L (3.5-5.3), and high TSI-antibodies level. The patient was diagnosed with Thyrotoxic periodic paralysis with Graves’ disease. He improved dramatically after intravenous potassium replacement. He has been started on Carbimazole and propranolol. Further workup showed normal levels of calcium, phosphorus, and basal metabolic panel. The patient had no remarkable central nervous system infections in the past, no exposure to lead or other heavy metals, and his family history was irrelevant. All in all, the suspicion of a potential association between Graves’ disease and basal ganglia calcification was raised.

Discussion:

Although it seems to be rare, this report suggests a possible association between Graves’ disease and basal ganglia calcification. Graves’ disease should be considered in the differential diagnosis in young patients with ganglia calcifications after ruling out other causes.