Anirban Majumder¹, Sagar Basu², Soumya Roy Choudhury^1,

Introduction: Recurrent laryngeal nerve injury and hypoparathyroidism are common complications of thyroid surgery. Hypoparathyroidism can cause carpopedal spasm, paresthesia, seizures and rarely movement disorders along with extensive intracranial calcification and many patients receive antiepileptic drugs for seizures without proper metabolic evaluation. Case: We report a 42 year old Indian female presenting with persistent ataxic gait with moderate truncal ataxia along with dyskinetic movements in both hands and slurred speech. She was operated for multinodular goiter (MNG) 21 years back – developed extensive intracranial calcification (diagnosed as Fahr’s Disease) and was put on Phenytoin therapy for repeated seizures about one year but seizures remain uncontrolled. Investigations revealed euthyroid state (with thyroxin replacement) along with features of hypoparathyroidism. She was treated accordingly which resulted in improvement of movement disorders quickly and seizure were also controlled. Phenytoin was successfully withdrawn with no further seizure. Discussion: Acquired hypoparathyroidism (Post-thyroid surgery here) is a common cause of intracranial calcifications (including Basal ganglia) which causes seizures and rarely movement disorders. This case was wrongly diagnosed as Fahr’s syndrome. All her symptoms improved after proper metabolic correction. Hence the importance of proper metabolic assessment in cases of seizures and movement disorders is emphasized here. Conclusions: Metabolic abnormalities should always be evaluated in patients with seizure disorder, especially if there is history of thyroid surgery and metabolic correction is more important than anticonvulsant medication and it improves almost all neurological problems including the movement disturbances and cerebellar ataxia.

thyroidectomy, hypoparathyroidism, hypomagnesemia