A Levothyroxine-related Paresthesia in a Middle-aged Female Patient after Receiving Hemithyroidectomy

A Levothyroxine-related Paresthesia in a Middle-aged Female Patient after Receiving Hemithyroidectomy

Paresthesia is a neuropathic pain, that is reported as pins-and-needle or tingling sensation, and may arise from an abnormality in the somatosensory system and other pain-processing brain regions. Here, I present the case of a patient who had paresthesia during levothyroxine treatment. The patient was a 57-year-old female nurse. When she was 49 years old, she had a neck mass found accidentally in her routine clinic visits for type 2 diabetes mellitus. She did not have any symptom before and after the neck mass was noted. In ultrasonography, this mass was found to be 2.95 cm × 2.33 cm in size, located in the largest section in the lower pole of the right side of the thyroid gland, with a well-defined margin. The diagnosis was a nontoxic thyroid nodule after a pathological examination. Seven years later, the size of the patient's nodule did not cause any discomfort, but she decided to have it removed. Before the surgical removal, she was in euthyroid state confirmed in February 2017, with the serum levels of triiodothyronine (T3, normal reference: 0.8-2 ng/mL), thyroxine (T4, normal reference: 5.1-14.1 μg/dL), and thyroid-stimulating hormone (TSH, normal reference: 0.27- 4.2 μIU/mL) being 1.24 ng/mL, 9.1 μg/dL, and 0.865 μIU/ mL, respectively. Besides, the serum level of thyroglobulin antibody was lower than 20 IU/mL (normal reference: < 40 IU/mL), and the serum level of the microsomal antibody was lower than 10 IU/mL (normal reference: < 35 IU/mL).