Thyroid Research and Practice

LETTER TO THE EDITOR
Year
: 2017  |  Volume : 14  |  Issue : 3  |  Page : 133-

Encephalopathy associated with autoimmune thyroid disease in an 11-year-old girl, a rare clinical presentation


Mahmood Dhahir Al-Mendalawi 
 Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
P.O. Box 55302, Baghdad Post Office, Baghdad
Iraq




How to cite this article:
Al-Mendalawi MD. Encephalopathy associated with autoimmune thyroid disease in an 11-year-old girl, a rare clinical presentation.Thyroid Res Pract 2017;14:133-133


How to cite this URL:
Al-Mendalawi MD. Encephalopathy associated with autoimmune thyroid disease in an 11-year-old girl, a rare clinical presentation. Thyroid Res Pract [serial online] 2017 [cited 2022 May 21 ];14:133-133
Available from: https://www.thetrp.net/text.asp?2017/14/3/133/216207


Full Text

Sir,

I read with interest the case report by Nayanar et al. on encephalopathy associated with autoimmune thyroid disease (ATD) in an 11-year-old girl.[1] The authors came to the diagnosis of hyperthyroid encephalopathy associated ATD based on suggestive clinical presentation and high thyroid profile with positive thyroperoxidase antibody.[1] It is obvious that ATD has been associated with a variety of connective tissue diseases, particularly systemic lupus erythematosus (SLE). Published data from India revealed protean SLE neuropsychiatric manifestations that might mimic those related to ATD.[2] The spectrum of thyroid disorders in SLE has been extensively studied in India where 36% of SLE patients had thyroid dysfunction.[3] Importantly, primary hypothyroidism was the most common dysfunction in 14%, while subclinical hypothyroidism and subclinical hyperthyroidism were seen in 12% and 2%, respectively.[3] It has been suggested that hyperthyroidism associated with SLE might be a form of presentation of thyroiditis and this association might pass unnoticed because of the similarity of some clinical manifestations. Moreover, ATD might precede or follow SLE.[4] I presume that the authors ought to consider SLE as a coexistent disease in the studied patient. Implementing appropriate tests, particularly estimating serum antinuclear antibodies, anti-dsDNA antibodies, anti-neuronal antibodies, and anti-ribosomal antibodies was envisaged. More importantly, measuring serum anti-histone antibodies ought to receive ample consideration as it has been noticed to be positive at the time of the onset of hyperthyroidism in SLE patients.[5] If that battery of tests disclosed underlying SLE, the case in question could be considered a novel case report as encephalopathy secondary to ATD-associated SLE has never been reported in the pediatric literature so far.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Nayanar MC, Vadalivala S, Noorani T, Shah H. Encephalopathy associated with autoimmune thyroid disease in an 11-year-old girl, a rare clinical presentation. Thyroid Res Pract 2017;14:38-40.
2Pradhan V, Patwardhan M, Rajadhyaksha A, Dhawale N, Ghosh K. Neuropsychiatric manifestations and associated autoantibodies in systemic lupus erythematosus patients from Western India. Rheumatol Int 2015;35:541-5.
3Kumar K, Kole AK, Karmakar PS, Ghosh A. The spectrum of thyroid disorders in systemic lupus erythematosus. Rheumatol Int 2012;32:73-8.
4Rodrigué S, Laborde H, Catoggio PM. Systemic lupus erythematosus and thyrotoxicosis: A hitherto little recognised association. Ann Rheum Dis 1989;48:424-7.
5Baleva M, Nikolov K, Manov E, Stoikov A, Shabani R, Dourmishev L, et al. The coexistence of systemic lupus erythematosus and thyrotoxicosis: The diagnostic value of antihistone antibodies. Case Rep Rheumatol 2012;2012:517059.