Autoimmune alternating hyper- and hypo-thyroidism: a rare condition in pediatrics

Area of Science:

• Endocrinology
• Immunology
• Pediatrics

Background:

• Alternating hyper- and hypothyroidism can result from the co-occurrence of thyroid stimulating autoantibodies (TSAbs) and TSH blocking autoantibodies (TBAbs).
• This condition is exceptionally rare, particularly in the pediatric population.
• The patient's clinical status fluctuates based on the dynamic balance between TSAbs and TBAbs.

Purpose of the Study:

• To describe a rare case of immune-mediated oscillating thyroid function in a 13-year-old adolescent.
• To highlight the diagnostic and therapeutic challenges associated with this condition in pediatric patients.

Main Methods:

• Case report of a 13-year-old adolescent with fluctuating thyroid function.
• Monitoring of thyroid function tests and antibody levels.
• Evaluation of therapeutic responses to levothyroxine and antithyroid drugs.

Main Results:

• The patient experienced alternating hyper- and hypothyroidism.
• Initial levothyroxine treatment was followed by a hyperthyroid state requiring antithyroid medication.
• The fluctuating thyroid function necessitated frequent therapeutic adjustments.

Conclusions:

• Autoimmune alternating hypo- and hyper-thyroidism is a rare pediatric condition potentially caused by simultaneous TSAbs and TBAbs.
• Management is complex, with options including radioactive iodine ablation, thyroidectomy, or pharmacological treatment.
• Definitive treatment may be considered due to the instability of thyroid function and the need for intensive monitoring.