engleski

Central nervous system involvement in children with autoimmune thyroid diseases

Central nervous system disorders are reported to be associated with Graves disease and Hashimoto’s thyroiditis, but rarely in children. Case report. We present two girls at the age of 14 and 17 years with euthyroid Hashimoto's thyroiditis and Graves disease who developed acute encephalopathy. The clinical picture was presented with headache, dizziness, double vision and, in girl with Hashimoto's thyroiditis, transitory alternating hemiparesis and cognitive decline. In both girls antithyroperoxidase antibody (TPOAb) were over 2000 IJ/mL (ref. value: <20 IJ/mL) and antithyroglobulin antibodies (TgAb) were 186 IJ/mL (ref. value <9 IJ/mL), in girl with Hashimoto’s thyroiditis. Analysis of cerebrospinal fluid (CSF) revealed blood-brain barriere damage (type II) with oligoclonal bands, pleocytosis (820/3 x 106 /L), elevated protein content (0.79 g/L), in girl with Hashimoto’s thyroiditis and normal cell and protein content in girl with Graves disease. EEG showed generalized high voltage slow wave activity. Brain MR revealed subcortical white matter hyperintensity, mostly in frontal and temporal lobe. Treatment with pulse methylprednisolone, intravenous immunoglobulin and azathioprine induced clinical remission. White matter abnormalities may develop in children with diagnosis of Hashimoto’s thyroiditis and Graves disease. Differential diagnosis in patients is very wide, including Hashimoto encephalopathy, multiple sclerosis, ADEM or other autoimmune diseases connected with CNS involvement. SREAT (steroid responsive encephalopathy associated with autoimmune thyroiditis) definitely should be considered as possible treatable autoimmune encephalopathy with variable clinical features, especially in paediatric patient.

autoimmune thyroid disease; encephalopathy; SREAT

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