Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) in childhood
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Abstract
Aim: Steroid responsive encephalopathy with autoimmune thyroiditis (SREAT) is a clinically and electrographically heterogeneous steroid-responsive encephalopathy associated with thyroid autoantibodies. We report an adolescent with SREAT and review PubMed literature relating to childhood.
Methods: A 14-year-old boy, without any preceding history of trauma, meningoencephalitis or seizures, was admitted in a comatose state. A similar episode of loss of consciousness 2 months prior with normal neuroimaging and electroencephalogram (EEG) had been followed by behavioral alterations. A year previously, during evaluation for increased appetite and poor weight gain, he was noted to have small goitre with thyroid-stimulating hormone (TSH) 7.26 mIU/L, T3 1.232 nmol/L, and T4 117.63 nmol/L. Routine hemogram, blood biochemistry, thyroid function tests including free hormone levels, ultrasonography thyroid and magnetic resonance imaging were normal. EEG showed diffuse slowing of all waves. Cerebrospinal fluid showed no pleocytosis and electrophoresis showed oligoclonal band. Viral studies and serum N-methyl-D-aspartate receptor antibody levels were negative. Anti-thyroid peroxidase (Anti-TPO) antibodies were raised. Intervention was with intravenous dexamethasone 4 mg every 6 h for 1 week followed by tapering schedule of oral prednisolone over 6 months.
Results: He regained consciousness after the second dose of dexamethasone and was discharged on day 7 in a fully conscious and ambulant state on a tapering course of low dose prednisolone for 6 months. He remains euthyroid with normal sensorium and behavior at 18 months follow-up. Only 50 cases below 18 years age were identified amongst 300 PubMed articles up to 31 July 2013.
Conclusion: Prompt steroid therapy following early recognition by high clinical suspicion and measurement of antithyroid antibody titers can lead to a favorable prognosis in SREAT.
References
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©2014 by Walter de Gruyter Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- Welcome to Assistant Editors at JPEM
- Review article
- Common approach to childhood obesity in Japan
- Images in pediatric endocrinology
- Aromatase deficiency in an adolescent girl misdiagnosed as congenital adrenal hyperplasia in infancy and childhood
- Original articles
- Prevalence of vitamin D deficiency among Iranian adolescents
- Analysis of body composition among children and adolescents – a cross-sectional study of the Polish population and comparison of body fat measurement methods
- Association of rs8066560 variant in the sterol regulatory element-binding protein 1 (SREBP-1) and miR-33b genes with hyperglycemia and insulin resistance
- Differences in anxiety and depression between male and female caregivers of children with a disorder of sex development
- Fasting and postprandial levels of a novel anorexigenic peptide nesfatin in childhood obesity
- The effect of growth hormone treatment on height in children with idiopathic short stature
- Clinical characteristics of type 1 diabetes over a 40 year period in Turkey: secular trend towards earlier age of onset
- Relationships of gamma-glutamyltransferase and beta 2-microglobulin on high sensitivity C-reactive protein among Japanese elementary school children
- Evaluation of insulin resistance and metabolic syndrome in a group of obese Czech children
- Circulating intact parathyroid hormone is suppressed at 25-hydroxyvitamin D concentrations >25 nmol/L in children
- Association between vitamin D level and cardiovascular risk in obese children and adolescents
- Serum paraoxonase activity and oxidative stress and their relationship with obesity-related metabolic syndrome and non-alcoholic fatty liver disease in obese children and adolescents
- Clinical features at diagnosis and responses to antithyroid drugs in younger children with Graves’ disease compared with adolescent patients
- Influence of hormonal parameters, bone mineral density and bone turnover on fracture risk in healthy male adolescents: a case control study
- Evaluation of lipid and glucose metabolism and cortisol and thyroid hormone levels in obese appropriate for gestational age (AGA) born and non-obese small for gestational age (SGA) born prepubertal Slovak children
- Chitotriosidase as a possible marker of clinically evidenced atherosclerosis in dyslipidemic children
- Exhaled carbon monoxide in adolescents with diabetic cardiovascular autonomic neuropathy
- Gut hormone profiles in preterm and term infants during the first 2 months of life
- Outcome analysis of aromatase inhibitor therapy to increase adult height in males with predicted short adult stature and/or rapid pubertal progress: a retrospective chart review
- A deletion including exon 2 of the TSHR gene is associated with thyroid dysgenesis and severe congenital hypothyroidism
- Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) in childhood
- Patient Reports
- Neonatal diabetes in an infant of diabetic mother: same novel INS missense mutation in the mother and her offspring
- Atypical neurologic presentations of new onset type 1 diabetes mellitus in pediatric age group: a report of five unusual cases and review of the literature
- Importance of dietary calcium and vitamin D in the treatment of hypercalcaemia in Williams-Beuren syndrome
- Vitamin D intoxication in two brothers: be careful with dietary supplements
- Transient diabetes insipidus in a preterm neonate and the challenge of desmopressin dosing
- A rare case of hypoglycaemia due to insulinoma in an adolescent with acutely altered mental status
- Holoprosencephaly: ZIC2 mutation in a case with panhypopituitarism
- An association of hypochondroplasia and immune deficiency
- Hypophosphatemic rickets caused by a novel PHEX gene mutation in an Indian girl
- Psoriasis vulgaris and autoimmune polyendocrine syndrome type I: a case report
- Identification of a combined missense/splice-site mutation in FAH causing tyrosinemia type 1
- Letter to the Editor
- Vitamin D intake and premature infants with intraventricular hemorrhage: how advisable is it?
Articles in the same Issue
- Frontmatter
- Editorial
- Welcome to Assistant Editors at JPEM
- Review article
- Common approach to childhood obesity in Japan
- Images in pediatric endocrinology
- Aromatase deficiency in an adolescent girl misdiagnosed as congenital adrenal hyperplasia in infancy and childhood
- Original articles
- Prevalence of vitamin D deficiency among Iranian adolescents
- Analysis of body composition among children and adolescents – a cross-sectional study of the Polish population and comparison of body fat measurement methods
- Association of rs8066560 variant in the sterol regulatory element-binding protein 1 (SREBP-1) and miR-33b genes with hyperglycemia and insulin resistance
- Differences in anxiety and depression between male and female caregivers of children with a disorder of sex development
- Fasting and postprandial levels of a novel anorexigenic peptide nesfatin in childhood obesity
- The effect of growth hormone treatment on height in children with idiopathic short stature
- Clinical characteristics of type 1 diabetes over a 40 year period in Turkey: secular trend towards earlier age of onset
- Relationships of gamma-glutamyltransferase and beta 2-microglobulin on high sensitivity C-reactive protein among Japanese elementary school children
- Evaluation of insulin resistance and metabolic syndrome in a group of obese Czech children
- Circulating intact parathyroid hormone is suppressed at 25-hydroxyvitamin D concentrations >25 nmol/L in children
- Association between vitamin D level and cardiovascular risk in obese children and adolescents
- Serum paraoxonase activity and oxidative stress and their relationship with obesity-related metabolic syndrome and non-alcoholic fatty liver disease in obese children and adolescents
- Clinical features at diagnosis and responses to antithyroid drugs in younger children with Graves’ disease compared with adolescent patients
- Influence of hormonal parameters, bone mineral density and bone turnover on fracture risk in healthy male adolescents: a case control study
- Evaluation of lipid and glucose metabolism and cortisol and thyroid hormone levels in obese appropriate for gestational age (AGA) born and non-obese small for gestational age (SGA) born prepubertal Slovak children
- Chitotriosidase as a possible marker of clinically evidenced atherosclerosis in dyslipidemic children
- Exhaled carbon monoxide in adolescents with diabetic cardiovascular autonomic neuropathy
- Gut hormone profiles in preterm and term infants during the first 2 months of life
- Outcome analysis of aromatase inhibitor therapy to increase adult height in males with predicted short adult stature and/or rapid pubertal progress: a retrospective chart review
- A deletion including exon 2 of the TSHR gene is associated with thyroid dysgenesis and severe congenital hypothyroidism
- Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) in childhood
- Patient Reports
- Neonatal diabetes in an infant of diabetic mother: same novel INS missense mutation in the mother and her offspring
- Atypical neurologic presentations of new onset type 1 diabetes mellitus in pediatric age group: a report of five unusual cases and review of the literature
- Importance of dietary calcium and vitamin D in the treatment of hypercalcaemia in Williams-Beuren syndrome
- Vitamin D intoxication in two brothers: be careful with dietary supplements
- Transient diabetes insipidus in a preterm neonate and the challenge of desmopressin dosing
- A rare case of hypoglycaemia due to insulinoma in an adolescent with acutely altered mental status
- Holoprosencephaly: ZIC2 mutation in a case with panhypopituitarism
- An association of hypochondroplasia and immune deficiency
- Hypophosphatemic rickets caused by a novel PHEX gene mutation in an Indian girl
- Psoriasis vulgaris and autoimmune polyendocrine syndrome type I: a case report
- Identification of a combined missense/splice-site mutation in FAH causing tyrosinemia type 1
- Letter to the Editor
- Vitamin D intake and premature infants with intraventricular hemorrhage: how advisable is it?
