MULTIPLE CRANIAL NERVE PALSIES ASSOCIATED WITH THYROID AUTOIMMUNITY: HASHIMOTO'S THYROIDITIS- A CASE REPORT

2021 ◽  
pp. 51-52
Author(s):  
Neeraja Ponnala ◽  
Stephen Abraham Suresh Kumar ◽  
J.Senthil Nathan
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Cranial Nerve ◽  
Thyroid Autoimmunity ◽  
Cranial Nerves ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Cranial Nerve Involvement ◽  
Cognitive Changes ◽  
Cranial Nerve Palsies ◽  
Multiple Cranial Nerve

Hashimotos's encephalopathy is an uncommon neurologic syndrome associated with Hashimoto's thyroiditis. Sometimes it may manifest years before onset of thyroid disease. The patients are usually euthyroid or midly hypothyroid. Antibodies against thyroid peroxidase are useful diagnostic marker of Hashimoto's thyroiditis. High levels of this antibody are associated with high 1 prevalence of hashimoto's encephalopathy . Clinical features are variable includes behavioral and cognitive changes, myoclonus, seizures, hemiparesis, involuntary movements, cerebellar signs, psychosis and coma, with relapsing and progressive course. Diagnosis is often overlooked but it is important as it is treatable cause of encephalopathy. Multiple cranial nerves involvement in Hashimoto's thyroiditis was reported in a very few patients, a rare association. Here we present a case of multiple cranial nerve involvement in a case of hashimoto's thyroiditis.

scholarly journals Tumors Presenting as Multiple Cranial Nerve Palsies

2017 ◽  
Vol 9 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Kishore Kumar ◽  
Rafeeq Ahmed ◽  
Bharat Bajantri ◽  
Amandeep Singh ◽  
Hafsa Abbas ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Systemic Disease ◽  
Cranial Nerves ◽  
B Cell Lymphoma ◽  
Abducens Nerve ◽  
Cranial Nerve Involvement ◽  
Nerve Involvement ◽  
Cranial Nerve Palsies ◽  
Multiple Cranial Nerve

Cranial nerve palsy could be one of the presenting features of underlying benign or malignant tumors of the head and neck. The tumor can involve the cranial nerves by local compression, direct infiltration or by paraneoplastic process. Cranial nerve involvement depends on the anatomical course of the cranial nerve and the site of the tumor. Patients may present with single or multiple cranial nerve palsies. Multiple cranial nerve involvement could be sequential or discrete, unilateral or bilateral, painless or painful. The presentation could be acute, subacute or recurrent. Anatomic localization is the first step in the evaluation of these patients. The lesion could be in the brain stem, meninges, base of skull, extracranial or systemic disease itself. We present 3 cases of underlying neoplasms presenting as cranial nerve palsies: a case of glomus tumor presenting as cochlear, glossopharyngeal, vagus and hypoglossal nerve palsies, clivus tumor presenting as abducens nerve palsy, and diffuse large B-cell lymphoma presenting as oculomotor, trochlear, trigeminal and abducens nerve palsies due to paraneoplastic involvement. History and physical examination, imaging, autoantibodies and biopsy if feasible are useful for the diagnosis. Management outcomes depend on the treatment of the underlying tumor.

scholarly journals Angioedema in a Patient with Autoimmune Thyroiditis – A Case Report

2020 ◽  
Vol 47 (2) ◽  
pp. 34-37
Author(s):  
S. Dermendzhiev ◽  
A. Dzhambov ◽  
T. Dermendzhiev
Keyword(s):  
Autoimmune Thyroiditis ◽  
Hashimoto’S Thyroiditis ◽  
Immunoglobulin E ◽  
Thyroid Autoimmunity ◽  
Hormonal Control ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Normal Range ◽  
History Of ◽  
One Year

AbstractWe present a case of a 29-year-old Bulgarian woman with autoimmune thyroiditis and recurrent angioedema. The patient presented with a one-year-long history of recurrent angioedema and Hashimoto’s thyroiditis. Physical examination showed oedema surrounded by erythema on the forearms, and erythematous, itchy plaques spreading over her face, neck, chest, abdomen, and extremities. Blood tests showed elevated total immunoglobulin E (IgE). The patient had been diagnosed with Hashimoto’s thyroiditis and hypothyroidism. She had been taking levothyroxine 50 μg/d, resulting in a good hormonal control; however, her anti-thyroid peroxidase (anti-TPO) antibodies were high. She was started on methylprednisolone and antihistamines. In three weeks, we observed a good therapeutic response to the treatment and the lesions remitted. IgE dropped within normal range. Levels of anti-TPO antibodies were persistently high. In conclusion, patients with angioedema should be tested for thyroid autoimmunity. Further delve into the pathogenesis of angioedema in them is warranted in order to explore the possibility of an underlying atopy in those not responding to the standard treatment with levothyroxine.

scholarly journals Antibodies to Thyroid Peroxidase Arise Spontaneously with Age in NOD.H-2h4 Mice and Appear after Thyroglobulin Antibodies

2010 ◽  
Vol 31 (4) ◽  
pp. 600-600
Author(s):  
Chun-Rong Chen ◽  
Sepehr Hamidi ◽  
Helen Braley-Mullen ◽  
Yuji Nagayama ◽  
Catherine Bresee ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Time Course ◽  
Thyroid Autoimmunity ◽  
Cross Reactivity ◽  
Eukaryotic Cells ◽  
Human Thyroid ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Thyroglobulin Antibodies ◽  
Self Tolerance

Abstract Hashimoto’s thyroiditis, a common autoimmune disease, is associated with autoantibodies to thyroglobulin (Tg) and thyroid peroxidase (TPO). TPO, unlike abundant and easily purified Tg, is rarely investigated as an autoantigen in animals. We asked whether antibodies (Abs) develop to both TPO and Tg in thyroiditis in mice that is induced (C57BL/6 and DBA/1 strains) or arises spontaneously (NOD.H-2h4). Screening for TPOAbs was performed by flow cytometry using mouse TPO-expressing eukaryotic cells. Sera were also tested for binding to purified mouse Tg and human TPO. The antibody data were compared with the extent of thyroiditis. Immunization with mouse TPO adenovirus broke self-tolerance to this protein in C57BL/6 mice, but thyroiditis was minimal and TgAbs were absent. In DBA/1 mice with extensive granulomatous thyroiditis induced by Tg immunization, TPOAbs were virtually absent despite high levels of TgAbs. In contrast, antibodies to mouse TPO, with minimal cross-reactivity with human TPO, arose spontaneously in older (7–12 months) NOD.H-2h4 mice. Unexpectedly, TgAbs preceded TPOAbs, a time course paralleled in relatives of probands with juvenile Hashimoto’s thyroiditis. These findings demonstrate a novel aspect of murine and human thyroid autoimmunity, namely breaking B cell self-tolerance occurs first for Tg and subsequently for TPO.

The Effect of Hypolipidemic Agents on Thyroid Autoimmunity in Women with Hashimoto’s Thyroiditis Treated with Levothyroxine and Selenomethionine

2017 ◽  
Vol 126 (05) ◽  
pp. 321-326 ◽  
Author(s):  
Robert Krysiak ◽  
Witold Szkróbka ◽  
Bogusław Okopień
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Plasma Lipids ◽  
Thyroid Autoimmunity ◽  
Hdl Cholesterol ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Free Triiodothyronine ◽  
Hypolipidemic Agents ◽  
Antibody Titers ◽  
Group B

Abstract Background Levothyroxine and selenomethionine were found to reduce thyroid antibody titers in patients with Hashimoto’s thyroiditis. The same effect was produced by intensive statin therapy. The aim of the present study was to assess whether hypolipidemic agents modulate the impact of thyroid hormone supplementation and selenomethionine on thyroid autoimmunity. Methods The study included 62 women with Hashimoto's thyroiditis treated for at least 6 months with levothyroxine and selenomethionine. On the basis of plasma lipids, women were divided into three groups: women with isolated hypercholesterolemia (group A; n=20), women with isolated hypertriglyceridemia (group B; n=17), and women with normal plasma lipids (group C; n=25). Group A were then treated with atorvastatin (20 mg daily), while group B received micronized fenofibrate (200 mg daily). Serum titers of thyroid peroxidase and thyroglobulin antibodies, as well as serum levels of thyrotropin, free thyroxine and free triiodothyronine were measured at the beginning of the study and 6 months later. Results Fenofibrate decreased triglycerides and increased HDL cholesterol, while simvastatin decreased total and LDL cholesterol. Fenofibrate reduced titers of thyroid peroxidase and, to a lesser extent, thyroglobulin antibodies. Atorvastatin tended to increase thyroid peroxidase antibodies. No changes in thyrotropin, free thyroxine and free triiodothyronine were observed in any treatment group. Fenofibrate-induced changes in thyroid antibody titers correlated with baseline antibody titers, as well as with treatment-induced changes in HDL cholesterol and insulin sensitivity. Conclusions The obtained results indicate that only fibrates may potentiate the effect of selenomethionine and levothyroxine on thyroid autoimmunity in women.

Isolated inflammatory sphenoiditis with multiple unilateral cranial nerve palsies

2006 ◽  
Vol 121 (2) ◽  
pp. 186-188 ◽  
Author(s):  
S Shukla ◽  
S M Keh ◽  
P Andrews ◽  
H Saleh
Keyword(s):  
Cranial Nerve ◽  
Middle Eastern ◽  
Cranial Nerves ◽  
Rare Entity ◽  
Cranial Nerve Involvement ◽  
Nerve Involvement ◽  
Cranial Nerve Palsies ◽  
Abducent Nerve ◽  
Specific Symptoms ◽  
Inflammatory Changes

Isolated sphenoidits is a rare entity that often presents with vague, non-specific symptoms. We present the case of a 36-year-old Middle Eastern man, who developed headache and a painful right eye. A diagnosis of acute sphenoiditis was made. Shortly afterwards, he developed diplopia due to isolated abducent nerve involvement. Within two months, the extent of cranial nerve involvement had increased to include cranial nerves II, III, and V. Subsequently, this was treated by functional endoscopic sinus surgical drainage and biopsy. Histology revealed inflammatory changes. The patient made a dramatic recovery post-operatively, with resolution in all symptoms.

scholarly journals Serum resolvin E1 levels and its relationship with thyroid autoimmunity in Hashimoto’s thyroiditis: a preliminary study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Song ◽  
Rongxin Sun ◽  
Yuanyuan Zhang ◽  
Jing Ke ◽  
Dong Zhao
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Protective Factor ◽  
Thyroid Autoimmunity ◽  
Hashimoto's Thyroiditis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Thyroid Peroxidase ◽  
Healthy Controls ◽  
Omega 3 ◽  
Free T4 ◽  
Ordinal Logistic Regression Analysis

Abstract Background Omega-3 polyunsaturated fatty acids (PUFAs) produce lipid mediators with both anti-inflammatory and pro-resolution properties, including resolvins. The purpose of this study was to detect serum resolvin E1 (RVE1) levels in Hashimoto’s thyroiditis (HT) patients and healthy controls (HCs) and to evaluate the relationship of RVE1 with thyroid autoimmunity. Methods A total of 57 participants were recruited, including 30 untreated HT patients and 27 age- and sex‐matched HCs. The levels of RVE1 in serum were measured via enzyme-linked immunosorbent assay (ELISA). An electrochemiluminescence immunoassay was used for the measurement of thyroid-stimulating hormone (TSH), total T4 (TT4), TT3, free T4 (FT4), FT3, anti-thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb) levels. Hemogram tests and routine biochemical analyses were performed on each sample. Results The serum level of RVE1 of HT patients (24.09, 15.76–34.38 pg/mL) was significantly lower than that of healthy controls (28.51, 20.76–51.23 pg/mL) (P = 0.027). RVE1 levels showed a downward trend with increasing TgAb levels (P for trend = 0.001). Multivariable ordinal logistic regression analysis showed that RVE1 levels were negatively correlated with increasing TgAb levels in both the unadjusted (OR = 0.9446, 95 % CI = 0.9111–0.9782, P = 0.002) and adjusted models (OR = 0.9380, 95 % CI = 0.8967–0.9811, P = 0.005). Conclusions Decreased RVE1 levels might be a sign that HT is associated with inflammatory resolution dysfunction. RVE1 may serve as a protective factor against increased TgAb levels.

scholarly journals Effects of vitamin D on thyroid autoimmunity markers in Hashimoto’s thyroiditis: systematic review and meta-analysis

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110606
Author(s):  
Jingwen Zhang ◽  
Yuting Chen ◽  
Hongyan Li ◽  
Hong Li
Keyword(s):  
Vitamin D ◽  
Hashimoto’S Thyroiditis ◽  
Meta Analysis ◽  
Thyroid Autoimmunity ◽  
Vitamin D Supplementation ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Randomized Controlled

Objective To perform a meta-analysis of randomized controlled trials to evaluate the efficacy of vitamin D supplementation on thyroid autoimmunity markers in Hashimoto’s thyroiditis (HT). Methods This meta-analysis included randomized controlled clinical trials identified by a systematic search of electronic databases (PubMed®, MEDLINE®, EMBASE, The Cochrane Library, China National Knowledge Infrastructure) from inception to August 2020. All studies included patients with HT that received vitamin D supplementation irrespective of the doses administered or the duration of treatment. The primary and secondary outcome measures were thyroid peroxidase antibody (TPOAb) and/or thyroglobulin antibody (TGAb) titres. Results Eight studies ( n = 652) were included. There was significant heterogeneity between the studies. Using a random-effect model, vitamin D supplementation reduced TPOAb titre (standardized mean difference [SMD]: –1.11; 95% confidence interval [CI]: 1–1.92, –0.29) and TGAb titre (SMD: –1.12; 95% CI: –1.96, –0.28). A subgroup analysis demonstrated that vitamin D supplementation for >3 months resulted in a decrease in TPOAb titre (SMD: –1.66, 95% CI: –2.91, –0.41) but treatment ≤3 months was ineffective. Treatment with vitamin D3 decreased TPOAb titre (SMD: –1.48; 95% CI: –2.53, –0.42) whereas vitamin D did not. Conclusion These data suggest that vitamin D reduces autoantibody titre in patients with HT.

scholarly journals Antibodies to Thyroid Peroxidase Arise Spontaneously with Age in NOD.H-2h4 Mice and Appear after Thyroglobulin Antibodies

Endocrinology ◽  
2010 ◽  
Vol 151 (9) ◽  
pp. 4583-4593 ◽  
Author(s):  
Chun-Rong Chen ◽  
Sepehr Hamidi ◽  
Helen Braley-Mullen ◽  
Yuji Nagayama ◽  
Catherine Bresee ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Time Course ◽  
Thyroid Autoimmunity ◽  
Cross Reactivity ◽  
Eukaryotic Cells ◽  
Human Thyroid ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Thyroglobulin Antibodies ◽  
Self Tolerance

Hashimoto’s thyroiditis, a common autoimmune disease, is associated with autoantibodies to thyroglobulin (Tg) and thyroid peroxidase (TPO). TPO, unlike abundant and easily purified Tg, is rarely investigated as an autoantigen in animals. We asked whether antibodies (Abs) develop to both TPO and Tg in thyroiditis that is induced (C57BL/6 and DBA/1 mice) or arises spontaneously (NOD.H-2h4 mice). Screening for TPOAbs was performed by flow cytometry using mouse TPO-expressing eukaryotic cells. Sera were also tested for binding to purified mouse Tg and human TPO. The antibody data were compared with the extent of thyroiditis. Immunization with mouse TPO adenovirus broke self-tolerance to this protein in C57BL/6 mice, but thyroiditis was minimal and TgAbs were absent. In DBA/1 mice with extensive granulomatous thyroiditis induced by Tg immunization, TPOAbs were virtually absent despite high levels of TgAbs. In contrast, antibodies to mouse TPO, with minimal cross-reactivity with human TPO, arose spontaneously in older (7–12 months) NOD.H-2h4 mice. Unexpectedly, TgAbs preceded TPOAbs, a time course paralleled in relatives of probands with juvenile Hashimoto’s thyroiditis. These findings demonstrate a novel aspect of murine and human thyroid autoimmunity, namely breaking B cell self-tolerance occurs first for Tg and subsequently for TPO.

scholarly journals Serum Resolvin E1 Levels and Its Relationship with Thyroid Autoimmunity in Hashimoto's Thyroiditis

2020 ◽  
Author(s):  
Jing Song ◽  
Rongxin Sun ◽  
Yuanyuan Zhang ◽  
Jing Ke ◽  
Dong Zhao
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Protective Factor ◽  
Thyroid Autoimmunity ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Omega 3 ◽  
Clinical Indicators ◽  
Thyroglobulin Antibody ◽  
Ordinal Logistic Regression Analysis

Abstract Objective: Omega-3 polyunsaturated fatty acids (PUFAs) can produce lipid mediators with both anti-inflammatory and pro-resolution properties, including resolvins. Resolvins have been associated with autoimmune disorders. This study aimed to measure the level of resolvin E1 (RVE1) in the serum of Hashimoto's thyroiditis (HT) patients and healthy controls (HCs) and to further analyze its correlation with thyroid autoantibodies and other clinical indicators.Design, patients and measurements: Fifty-seven participants were recruited—30 untreated HT patients and 27 sex‐ and age‐matched HCs. Levels of serum RVE1 were measured by ELISA according to the manufacturer’s protocol. Serum total T3 (TT3), TT4, free T3 (FT3), FT4, thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb) and thyroid-stimulating hormone (TSH) levels were measured using an electrochemiluminescence immunoassay. Routine biochemical and hemogram tests were performed on each sample.Results: Serum RVE1 levels in HT patients (24.09, 15.76-34.38 pg/mL) were significantly lower than those in HCs (28.51, 20.76-51.23 pg/mL) (P=0.027). As the TgAb level increased, the RVE1 content showed a decreasing trend (P for trend=0.001). Multivariable ordinal logistic regression analysis showed that RVE1 was negatively correlated with increasing TgAb in both the unadjusted (OR=0.9446, 95% CI=0.9111-0.9782, P=0.002) and adjusted models (OR=0.9380, 95% CI=0.8967-0.9811, P=0.005).Conclusions: Decreased RVE1 levels indicate impaired resolution of inflammation in HT patients. RVE1 may be a protective factor for elevated TgAb levels.

scholarly journals Ramsay Hunt Syndrome with multiple cranial nerve palsy

2012 ◽  
Vol 18 (2) ◽  
pp. 231-233
Author(s):  
KA Al Mahmud ◽  
Kamal Uddin ◽  
Maleka Afroz
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Cranial Nerve Involvement ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome ◽  
Nerve Involvement ◽  
Cranial Nerve Palsies ◽  
Multiple Cranial Nerve Palsy ◽  
Multiple Cranial Nerve

Ramsay Hunt Syndrome classically presents with VII nerve palsy. Other cranial nerve involvement is rare. We describe a case here who presented with VII, IX and X cranial nerve palsies and review the literature. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12029 Bangladesh J Otorhinolaryngol 2012; 18(2): 231-233

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