title: Cerebellar Ataxia from Multiple Potential Causes: Hypothyroidism, Hashimoto's Thyroiditis, Thalamic Stimulation, and Essential Tremor.
abstract: BACKGROUND
  Both hypothyroidism and Hashimoto's thyroiditis (HT) can rarely be associated with cerebellar ataxia. Severe essential tremor (ET) as well as bilateral thalamic deep brain stimulation (DBS) may lead to subtle cerebellar signs.
  
  
  METHODS
  We report a 74-year-old male with hypothyroidism and a 20-year history of ET who developed cerebellar ataxia after bilateral thalamic DBS. Extensive workup revealed elevated thyroid stimulating hormone and thyroperoxidase antibody titers confirming the diagnosis of HT.
  
  
  CONCLUSIONS
  Our case demonstrates multiple possible causes of cerebellar ataxia in a patient, including hypothyroidism, HT, chronic ET, and bilateral thalamic DBS. Counseling of patients may be appropriate when multiple risk factors for cerebellar ataxia coexist in one individual.
authors: Department of Neurology, Mayo Clinic, Scottsdale, Arizona, United States of America.
authors: Natalya
authors: N
authors: Shneyder
authors: Mark K
authors: MK
authors: Lyons
authors: Erika
authors: E
authors: Driver-Dunckley
authors: Virgilio Gerald H
authors: VG
authors: Evidente
keywords: Ataxia; Hashimoto's thyroiditis; deep brain stimulation; hypothyroidism; thalamic stimulation; tremor