Epilepsy & Treatment

Background: Essential tremor (ET) is a neurological disorder causing involuntary rhythmic tremors (4–12 Hz) and mostly

seen in adults of age 40 or more. ET is a clinical diagnosis and is commonly seen ipsilaterally, worsens with movement and

usually hands are involved initially. Physical and emotional stress, fatigue, low blood glucose level, alterations in temperature,

caffeinated drinks may trigger the condition. ET is not a life threatening condition but if the symptoms are severe, it may affect

the quality of life. Thyriod hormone is mainly required for growth and the development of organs including brain and skeletal

systems. Thyroid hemiagenesis (TH) is a rare, congenital disorder characterized by non-development of a lobe of the thyroid

gland.

Case: A 23 year old female patient having bilateral tremor for approximately 10 years, intensifying with motion presented to

the neurology outpatient clinic for the very first time. Muscle tone and strength, deep tendon reflexes, sensual examination,

posture, balance and coordination and walking were evaluated as part of the usual neurological examination. Routine

biochemistry, hemogram and thyroid function tests were performed and found as normal, except vitamin B12 deficiency

(176). Known disease, past surgery, exposure to heavy metals and drug use were not present in patient’s history. The patient

lacks history of alcohol and smoking; caffeine use was limited to 1–2 cups of tea/day. The patient had no family history of

essential tremor or Parkinson’s disease. The patient had strain while performing activities such as drinking water from a glass

and drawing circles. Tremor was leading to difficulty in daily life activities and functional loss. Thyroid gland ultrasonography

was performed for advanced study to enlighten essential tremor etiology: agenesis was discovered in thyroid left lobe and the

size of the right lobe was 22*12 mm.

Conclusion: This case was presented due to the lack of similar case in literature. The patient was examined for increased

essential tremor, and hemigenesis in thyroid gland was detected. Female gender and thyroid left lobe agenesis were coherent

with literature for TH. Even though no failure was found in thyroid function tests, it may have an association in cellular level

triggering essential tremor. Further studies are needed to investigate the relation between two diseaeses.