2-[18F]fluoro-2-deoxy-D-glucose PET-CT in a case of cerebellar ataxia associated thyroid disorder

Auto-immune hypothyroidism being the common cause of hypothyroidism with usual clinical features like constipation, fatigue, cold intolerance and weight gain can rarely present with neurologic problems like reversible cerebellar ataxia, dementia, peripheral neuropathy, psychosis and coma. In this manuscript we present a case that was evaluated with a suspicion of paraneoplastic syndrome for cerebellar ataxia. 2-[F-18]fluoro-2-deoxy-D-glucose ([(18) F]FDG) PET-CT scan showed diffuse hypometabolism in both cerebellar lobes and diffusely increased metabolic activity in thyroid gland. Further investigations revealed the hypothyroidism with positive Anti-TPO antibody. Thyroid replacement therapy was started and patient showed significant clinical as well as biochemical improvement after 3 weeks. The main aim of this case report is to highlight the fact that hypothyroidism has to be considered in all patients who present with acute onset of cerebellar ataxia and [F-18]FDG PET-CT scan was helpful as imaging modality in this case.