Auto-destruction of the thyroid gland and coexisting glutamic acid decarboxylase mediated neurological disease in an adolescent: an unusual presentation of autoimmunity
-
Deepa Badrinath Murthy
,
Ana Gutierrez Alvarez
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.
-
Research funding: None declared.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Written informed consent was obtained.
-
Ethical approval: The authors consciously assure that for this manuscript, the following are fulfilled: 1) This material is the authors’ own original work, which has not been previously published elsewhere. 2) The paper is not currently being considered for publication elsewhere. 3) The paper reflects the authors’ own research and analysis in a truthful and complete manner. 4) The paper properly credits the meaningful contributions of co-authors and co-researchers. 5) The results are appropriately placed in the context of prior and existing research. 6) All sources used are properly disclosed (correct citation). 7) All authors have been personally and actively involved in substantial work leading to the paper, and will take public responsibility for its content.
References
1. Carlé, A, Pedersen, IB, Knudsen, N, Perrild, H, Ovesen, L, Jørgensen, T, et al.. Thyroid volume in hypothyroidism due to autoimmune disease follows a unimodal distribution: evidence against primary thyroid atrophy and autoimmune thyroiditis being distinct diseases. J Clin Endocrinol Metab 2009;94:833–9. https://doi.org/10.1210/jc.2008-1370.Search in Google Scholar PubMed
2. BakerJr.JR. Dying (apoptosing?) for a consensus on the Fas death pathway in the thyroid. J Clin Endocrinol Metab 1999;84:2593–5. https://doi.org/10.1210/jcem.84.8.5993.Search in Google Scholar PubMed
3. Graus, F, Saiz, A, Dalmau, J. GAD antibodies in neurological disorders – insights and challenges. Nat Rev Neurol 2020;16:353–65. https://doi.org/10.1038/s41582-020-0359-x.Search in Google Scholar PubMed
4. Nakajima, H, Nakamura, Y, Inaba, Y, Tsutsumi, C, Unoda, K, Hosokawa, T, et al.. Neurologic disorders associated with anti-glutamic acid decarboxylase antibodies: a comparison of anti-GAD antibody titres and time-dependent changes between neurologic disease and type I diabetes mellitus. J Neuroimmunol 2018;317:84–9. https://doi.org/10.1016/j.jneuroim.2018.01.007.Search in Google Scholar PubMed
5. Zimmermann, MB, Hess, SY, Molinari, L, De Benoist, B, Delange, F, Braverman, LE, et al.. New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report. Am J Clin Nutr 2004;79:231–7. https://doi.org/10.1093/ajcn/79.2.231.Search in Google Scholar PubMed
6. Mikoś, H, Mikoś, M, Obara-Moszyńska, M, Niedziela, M. The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease (AITD). Endokrynol Pol 2014;65:150–5. https://doi.org/10.5603/EP.2014.0021.Search in Google Scholar PubMed
7. Chrobák, L. Clinical significance of soluble interleukin-2 receptor. Acta Med 1996;39:3–6.Search in Google Scholar
8. McKeon, A, Pittock, SJ. Paraneoplastic encephalomyelopathies: pathology and mechanisms. Acta Neuropathol 2011;122:381–400. https://doi.org/10.1007/s00401-011-0876-1.Search in Google Scholar PubMed
9. Boesen, MS, Born, AP, Lydolph, MC, Blaabjerg, M, Børresen, ML. Pediatric autoimmune encephalitis in Denmark during 2011–17: a nationwide multicenter population-based cohort study. Eur J Paediatr Neurol 2019;23:639–52. https://doi.org/10.1016/j.ejpn.2019.03.007.Search in Google Scholar PubMed
10. McKeon, A, Tracy, JA. GAD65 neurological autoimmunity. Muscle Nerve 2017;56:15–27. https://doi.org/10.1002/mus.25565.Search in Google Scholar PubMed
© 2021 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review Article
- Stretched penile length at birth: a systematic review
- Original Articles
- Global epidemiology of mucopolysaccharidosis type III (Sanfilippo syndrome): an updated systematic review and meta-analysis
- Cardiometabolic risk factors in children and adolescents from southern Brazil: comparison to international reference values
- Association of antimullerian hormone with the size of the appendix testis, the androgen and estrogen receptors and their expression in the appendix testis, in congenital cryptorchidism
- The utility of serum inhibin B, anti-Müllerian hormone and insulin growth factor-1 in predicting a positive response to GnRH analogs for diagnosing central precocious puberty in girls
- Growth response to growth hormone (GH) treatment in children with GH deficiency (GHD) and those with idiopathic short stature (ISS) based on their pretreatment insulin-like growth factor 1 (IGFI) levels and at diagnosis and IGFI increment on treatment
- Association of muscle mass and fat mass on low-density-lipoprotein cholesterol and triglyceride plasma concentration in children and adolescents
- The effect of sickle cell anemia on the linear growth of Nigerian children
- Size-adjustment techniques of lumbar spine dual energy X-ray absorptiometry measurements in assessing bone mineralization in children on maintenance hemodialysis
- Changes in the presentation of newly diagnosed type 1 diabetes in children during the COVID-19 pandemic in a tertiary center in Southern Turkey
- Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c
- Short Communication
- Anti-SARS-CoV-2 antibodies in new-onset type 1 diabetes in children during pandemic in Belgium
- Case Reports
- An intronic variant disrupts mRNA splicing and causes FGFR3-related skeletal dysplasia
- Auto-destruction of the thyroid gland and coexisting glutamic acid decarboxylase mediated neurological disease in an adolescent: an unusual presentation of autoimmunity
- Glycogen storage disease type XII; an ultra rare cause of hemolytic anemia and rhabdomyolysis: one new case report
- The clinical variations and diagnostic challenges of deoxyguanosine kinase deficiency: a descriptive case series
- Mild phenotype in two siblings with a missense GHR variant
Articles in the same Issue
- Frontmatter
- Review Article
- Stretched penile length at birth: a systematic review
- Original Articles
- Global epidemiology of mucopolysaccharidosis type III (Sanfilippo syndrome): an updated systematic review and meta-analysis
- Cardiometabolic risk factors in children and adolescents from southern Brazil: comparison to international reference values
- Association of antimullerian hormone with the size of the appendix testis, the androgen and estrogen receptors and their expression in the appendix testis, in congenital cryptorchidism
- The utility of serum inhibin B, anti-Müllerian hormone and insulin growth factor-1 in predicting a positive response to GnRH analogs for diagnosing central precocious puberty in girls
- Growth response to growth hormone (GH) treatment in children with GH deficiency (GHD) and those with idiopathic short stature (ISS) based on their pretreatment insulin-like growth factor 1 (IGFI) levels and at diagnosis and IGFI increment on treatment
- Association of muscle mass and fat mass on low-density-lipoprotein cholesterol and triglyceride plasma concentration in children and adolescents
- The effect of sickle cell anemia on the linear growth of Nigerian children
- Size-adjustment techniques of lumbar spine dual energy X-ray absorptiometry measurements in assessing bone mineralization in children on maintenance hemodialysis
- Changes in the presentation of newly diagnosed type 1 diabetes in children during the COVID-19 pandemic in a tertiary center in Southern Turkey
- Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c
- Short Communication
- Anti-SARS-CoV-2 antibodies in new-onset type 1 diabetes in children during pandemic in Belgium
- Case Reports
- An intronic variant disrupts mRNA splicing and causes FGFR3-related skeletal dysplasia
- Auto-destruction of the thyroid gland and coexisting glutamic acid decarboxylase mediated neurological disease in an adolescent: an unusual presentation of autoimmunity
- Glycogen storage disease type XII; an ultra rare cause of hemolytic anemia and rhabdomyolysis: one new case report
- The clinical variations and diagnostic challenges of deoxyguanosine kinase deficiency: a descriptive case series
- Mild phenotype in two siblings with a missense GHR variant
