AI Article Synopsis
- Hashimoto's thyroiditis (HT) is an autoimmune disorder that can lead to thyroid failure and, in rare cases, neurological issues associated with GAD antigen.
- A 7-year-old boy with symptoms like weight loss and abnormal gait was diagnosed with autoimmune hyperthyroidism and treated with methimazole, later developing hypothyroidism and epilepsy correlated to GAD-65 CNS disease.
- This case highlights an uncommon type of atrophic thyroiditis (AT) that also presents with neurological symptoms, emphasizing the need to consider GAD-65 autoimmunity in similar pediatric cases.
Article Abstract
Objectives: Hashimoto's thyroiditis (HT) is characterized by lymphocytic thyroid infiltration. Gradual thyroid failure can occur due to thyroid cell apoptosis. Rarely neurological autoimmunity due to glutamic acid decarboxylase (GAD) antigen can co exist with HT.
Case Presentation: A seven-year-old male presented with tiredness, weight loss, frequent falls, tachycardia, firm thyromegaly, and abnormal gait. Biochemical markers and thyroid ultrasound (TUS) showed autoimmune hyperthyroidism. Methimazole (MMI) was started and continued for 2.2 years. MRI brain was normal and neurological symptoms resolved. At nine years, he became hypothyroid and levothyroxine (LT4) was started. Serial TUS showed progressive thyroid atrophy. At 14.8 years, he developed epilepsy and fourth cranial nerve palsy, and diagnosed with GAD-65 central nervous system disease. At 15.3 years, TUS showed complete atrophy of right lobe with involuting left lobe volume.
Conclusions: This is an unusual form of atrophic thyroiditis (AT) with coexisting neurological autoimmunity. GAD-65 CNS autoimmunity should be considered in children with AT presenting with neurological signs.
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| http://dx.doi.org/10.1515/jpem-2020-0697 | DOI Listing |
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