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Thyroid Function and Anti-thyroid Antibodies in Pediatric Anti-NMDAR Encephalitis
Lianfeng Chen1, Wenlin Wu1, Yang Tian1
1Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Thyroid antibodies (ATAbs) and abnormal thyroid function are common in pediatric anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, often improving with treatment. Unlike adults, non-thyroidal illness syndrome (NTIS) may not correlate with clinical features in children.
Area of Science:
- Pediatric Neurology
- Endocrinology
- Immunology
Background:
- Adult anti-NMDAR encephalitis is associated with thyroid antibodies (ATAbs), thyroid hormone changes, and non-thyroidal illness syndrome (NTIS).
- NTIS is characterized by thyroid hormone inactivation, specifically low triiodothyronine (FT3) and high reverse triiodothyronine (FT3), with suppressed thyroid-stimulating hormone (TSH).
- Understanding these associations in pediatric cases is crucial for comprehensive patient management.
Purpose of the Study:
- To investigate the prevalence and clinical associations of thyroid function and ATAbs in pediatric anti-NMDAR encephalitis.
- To compare findings in pediatric patients with those previously reported in adults.
- To assess the potential impact of NTIS on clinical characteristics in pediatric anti-NMDAR encephalitis.
Main Methods:
- Retrospective analysis of clinical data from 51 pediatric patients diagnosed with anti-NMDAR encephalitis.
- Evaluation of thyroid antibody (ATAbs, TPOAb, TGAb) status and thyroid hormone levels (FT3, FT4, TSH).
- Diagnosis of NTIS based on characteristic thyroid hormone profiles.
Main Results:
- Over half of the patients (52.9%) were positive for ATAbs, with common co-positivity for anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TGAb).
- Thyroid function abnormalities (FT3, FT4, or TSH) were observed in 62.7% of patients, and 45.1% met criteria for NTIS.
- Thyroid antibodies and hormone levels showed improvement during treatment; ATAb-positive patients were older at onset and more likely to receive multiple courses of intravenous immunoglobulin (IVIg).
Conclusions:
- Anti-thyroid antibody positivity, thyroid hormone abnormalities, and NTIS are frequent findings in pediatric anti-NMDAR encephalitis.
- Thyroid-related abnormalities appear to be treatable and can improve alongside anti-NMDAR encephalitis treatment.
- Unlike in adults, NTIS does not seem to be associated with specific clinical characteristics in pediatric anti-NMDAR encephalitis patients.
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