Encefalopatía asociada a enfermedad tiroídea, un diagnóstico a tener en mente / Encephalopathy associated with thyroid disease, a diagnosis to take into account

Mujer de 54 años con antecedentes de Hipertensión arterial e Hipotiroidismo. Historia de aproximadamente 3 meses de evolución caracterizado al inicio por ánimo bajo, cambios en el comportamiento con aparición progresiva de conductas extraña, ideas delirantes y alucinaciones visuales y auditivas, junto con disminución en requerimientos de hormonas tiroídeas hasta la suspensión. Consulta en varios centros donde se cataloga como Trastorno depresivo severo con síntomas psicóticos, Síndrome confusional, Síndrome Psicótico. En este contexto se pesquisa Hipertiroidismo con títulos elevados de Anticuerpos Antitiroídeos e inicia tratamiento con Metimazol y Betabloqueo. Tras extenso estudio que descartan causas infecciosas, neoplásicas y autoinmunes; se inicia tratamiento con pulsos de Metilprednisolona con excelente y rápida respuesta clínica, la cual mantiene durante el curso del seguimiento con dosis decrecientes de corticoides.

A 54-year-old woman with a history of arterial hypertension and hypothyroidism. History of approximately 3 months of evolution characterized at the beginning by low mood, changes in behavior with progressive appearance of bizarre behaviors, delusional ideas and visual and auditory hallucinations. Consultation in several centers where it is classified as severe Depressive disorder with psychotic symptoms, Confusional syndrome, Psychotic syndrome. Hyperthyroidism is investigated with high titers of Antithyroid Antibodies and initiates treatment with Methimazole and Betablock. After extensive study that ruled out infectious, neoplastic and autoimmune causes; Treatment with Methylprednisolone pulses is initiated with excellent and rapid clinical response, which is maintained during the course of follow-up with decreasing doses of corticosteroid.

Encefalopatía respondedora a corticoides asociada a tiroiditis autoinmune (SREAT). Una causa no habitual de compromiso de conciencia en pediatría, reporte de 2 casos / Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT): an unusual cause of encephalopathy in children, report of two cases

Introduction: steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a rare condition in children. The pathogenesis and etiology of SREAT has not yet been clearly identified. Clinical features include acute or subacute encephalopathy with neuropsychiatric symptoms, associated with abnormally elevated thyroid antibodies (TA) and symptoms improvement with corticosteroid treatment. Methods and Patients: we present 2 clinical cases; the first a 6 years 8 months male with cephalic myoclonic seizures and behavioral changes, the second a 12 years 10 months female with 4 hospitalizations for encephatlopathy, dystonia and psychomotor agitation. In both patients thyroid function tests and TA were compatible with Hashimoto’s thyroiditis, this associated with neuropsychiatric symptoms did raise the diagnosis of SREAT. Glucocorticoid therapy was started, the first case showed remission of seizures and behavioral improvement, however the second patient had insufficient response, so second line therapy with intravenous immunoglobulin was introduced with good response. This therapy was supplemented by additional long-term glucocorticoids use but when suspended both patients presented relapsing symptoms. Conclusions: Although SREAT is rarely suspected at presentation, it is necessary to consider this diagnosis in patients with encephalopathy, neuropsychiatric symptoms and elevated TA. Further studies are required to elucidate the pathophysiology of this disease and follow-up work to assess comorbidities and long-term complications in pediatric patients.

Occurrence of diabetic ketoacidosis and autoimmune thyroiditis in a patient treated with pegylated interferon-alpha 2b and ribavirin for chronic hepatitis C / 대한간학회지

Combined pegylated interferon and ribavirin therapy for chronic hepatitis C infection cause a wide range of side effects, including flu-like syndrome, hematological abnormalities, cardiovascular symptoms, gastrointestinal symptoms, pulmonary dysfunction, depression, and retinopathy. Interferon-alpha has been shown to be related to the development of various autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, autoimmune thyroid disease, and type 1 diabetes mellitus (DM). Type 1 DM and thyroid disease respectively develop in 0.08~2.61% and 10~15% of patients treated with combined interferon-alpha and ribavirin for chronic hepatitis C. The coexistence of type 1 DM and autoimmune thyroiditis was rarely reported. We report a case of a 33-year-old female patient with chronic hepatitis C who simultaneously developed diabetic ketoacidosis and autoimmune thyroiditis after treatment with pegylated interferon-alpha 2b and ribavirin.

[Autoimmune thyroid disease. Clinical and biological correlations]

In this article, we analyze the clinical and biological data concerning the autoimmune thyroid diseases in patients recruited in an endocrinology clinic at the university hospital center of Hotel-Dieu de France between March 2005 and November 2005. We studied 121 patients [51 with Basedow disease and 70 with Hashimoto thyroiditis], between 13 and 68 years old, with a BMI of 24.68 kg/m[2] and with a female predominance [105 women]. Symptoms of hyperthyroidism represented the most frequent cause of consultation. The distribution of patients regarding their thyroid disease showed that 42.1% of patients had hyperthyroidism [only one patient had subclinical hyperthyroidism], 21.5% had a subclinical hypothy-roidism, 28.1% had clinical hypothyroidism and 83% had euthyroid goiter. Half of the patients had at least a member of their family whith a thyroid disease. The autoimmune thyroid diseases are strongly associated to other autoimmune diseases and to repetitive spontaneous abortion. Thus, 39% of the married women had had at least one spontaneous abortion and 26.4% of the patients had one or more autoimmune disease associated to their thyroid disease; diabetes mellitus type 1 representing the most frequent one. Concerning the treatment, we remarked a remission of 30 patients [66.7%] with Basedow disease after 18 months of anti-thyroid drug treatment of 45 patients. In Hashimoto thyroiditis, we remarked a frequent evolution of patients with subciinical hypothyroidism to overt hypothyroidism when medical treatment was not initiated

Expression of antithyroid antibodies in a large family with high prevalence of thyroid autommune disease and follow-up of patients with Grave's disease

This study included 40 families [179 persons] with familial goiter [more than one member in the family had goiter]. Fifteen families had Grave's disease, 85 had Hashimoto's thyroiditis, 6 in remission [defined as clinical and biochemical euthyroidism for at least one year after withdrawal treatment] and 73 relatives [parents and sibs]. Seventy-two age and sex matched healthy subjects were included as a normal control group. Thyroid function was evaluated at diagnosis by measuring free triiodothyronine [FT3], thyroxine [FT4] and thyroid stimulating hormone [TSH]. Antithyroglobulin [ATG] and antithyroid peroxidase [TPO] antibodies were also measured. At the follow up of patients with Grave's disease, 30 patients with Grave's disease were examined clinically and thyroid profile [FT3, FT4 and TSH] were performed after 4-8 weeks of starting antithyroid drugs [ATDs], then every 2-3 m, thereafter. Thyroid antibodies [ATPO and ATG] were done before the start of treatment and follow up antithyroid antibodies were measured after six months and one year. Thyroid imaging using Tc99m thyroid scan and thyroid ultrasound [US] were performed at diagnosis for all patients. It was concluded that anti TPO and anti TG represent an additional parameter with potential interest in the clinical diagnosis and Hashimoto's thyroiditis. ATDs are safe and remain the treatment of choice of Graves' disease in children and adolescents. However, a long-term follow up is required for these patients as a high relapse rate is observed

Tiroiditis de Hashimoto. Estudio de 100 casos

Presentamos 100 casos de tiroiditis de Hashimoto (TH) cuyo diagnóstico se basó en la presencia de bocio y anticuerpos antitiroideos positivos y/o informe de citología del aspirado de tiroides compatible con TH. El promedio de edad fue de 35 años con su mayor incidencia hacia la cuarta década de la vida; la razón mujer a hombre fue 24:1. A 62 pacientes se les realizó aspirado de tiroides; en 54 la citología fue informada como TH. Los anticuerpos antimicrosomales y antitiroglobulina fueron positivos en 83 por ciento y 52 por ciento de los pacientes respectivamente; ambos anticuerpos fueron negativos en 12 pacientes discriminados así: clínico en 57 y subclínico en 23. De los 20 pacientes eutiroideos, seis elevaron la TSH entre uno y medio y tres años después del diagnóstico. Los hallazgos predominantes en los estudios gamagráficos de tiroides con 99mTc fueron: bocio con distribución homogénea y normo o hipercaptación del radiotrazados. Concluimos que la TH no es tan rara en nuestro medio y que se requieren estudios de mayor envergadura para determinar su prevalencia.