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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


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

Date of Web Publication9-Oct-2017

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
P.O. Box 55302, Baghdad Post Office, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/trp.trp_20_17

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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

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 2020 Jan 23];14:133. Available from: http://www.thetrp.net/text.asp?2017/14/3/133/216207

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

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nayanar 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.  Back to cited text no. 1
  [Full text]  
2.
Pradhan 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.  Back to cited text no. 2
    
3.
Kumar K, Kole AK, Karmakar PS, Ghosh A. The spectrum of thyroid disorders in systemic lupus erythematosus. Rheumatol Int 2012;32:73-8.  Back to cited text no. 3
    
4.
Rodrigué S, Laborde H, Catoggio PM. Systemic lupus erythematosus and thyrotoxicosis: A hitherto little recognised association. Ann Rheum Dis 1989;48:424-7.  Back to cited text no. 4
    
5.
Baleva 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.  Back to cited text no. 5
    




 

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