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

Meenakshi Cheripady Nayanar, Shakil Vadalivala, Tabrez Noorani, Hiral Shah

Thyroid Research and Practice 2017 14(1):38-40

Encephalopathy associated with autoimmune thyroid disease (EAATD) is a rare clinical presentation in pediatric age group whose exact prevalence has not been precisely elucidated. EAATD is characterized by neurological and psychiatric symptoms, high levels of antithyroid antibodies, increased cerebrospinal fluid (CSF) protein concentration, nonspecific electroencephalogram abnormalities, and responsiveness to the corticosteroid treatment. We present a case of an 11-year-old female patient who presented with acute history of fever, irritability, double vision, altered behavior, and unsteady gait which progressed to altered sensorium with drowsiness, tremors, and ataxia. The child had exophthalmos which was long standing in view of which thyroid profile was sent. Preliminary work-up, CSF analysis, and neuroimaging with magnetic resonance imaging of the brain proved normal. Thyroid profile was high with positive thyroperoxidase antibody. Thus, we came to the diagnosis of EAATD. EAATD still requires a better definition of its pathophysiology, the diagnostic criteria, and the most appropriate management including the long-term follow-up of patients.

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