![]() ![]() ![]() However, few such reports are addressing pediatric anti-NMDAR encephalitis. Non-thyroidal illness syndrome (NTIS) is characterized by thyroid hormone inactivation, with low triiodothyronine and high reverse triiodothyronine, followed by suppressed thyroid-stimulating hormone (TSH) NTIS is associated with clinical characteristics of adult anti-NMDAR encephalitis ( 11). Recent studies have reported thyroid antibody ( 10) and hormone ( 11) changes in adult anti-NMDAR encephalitis associated with disease severity. Studies have found that thyroid hormones affect the prognosis of critical and severe diseases, besides substance metabolism, growth, and development ( 9). In addition, hypothyroidism is associated with a decreased hippocampus size, which is a major area involved in anti-NMDAR encephalitis ( 1, 8). During brain development, thyroid hormones play an important role in the proliferation and differentiation of neuronal and glial progenitors ( 6, 7). Thyroid hormones are essential in humans. Thyroid antibodies are frequently detected not only in patients with autoimmune thyroid disease but also in individuals without overt thyroid dysfunction, including those with rheumatoid arthritis, type 1 diabetes mellitus, Crohn's disease, and neurological disorders such as multiple sclerosis ( 5). Anti-NMDAR encephalitis can be accompanied with other autoantibodies such as the myelin oligodendrocyte glycoprotein antibody ( 3), similar to other immune-mediated diseases, presenting more than one immune disorder together ( 4). The common clinical manifestations of anti-NMDAR encephalitis include psychiatric symptoms, behavioral dysfunction, seizures, movement disorder, speech disorder, cognitive impairment, decreased consciousness, autonomic dysfunction, or central hypoventilation ( 2). Unlike adult anti-NMDAR encephalitis, NTIS might not be associated with the clinical characteristics of anti-NMDAR encephalitis in pediatric patients.Īnti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder associated with autoantibodies binding with the NR1 subunit of the NMDAR receptor ( 1). Cases with ATAbs (+) are at older onset ages and more likely to be treated by intravenous immunoglobulin therapy more than once. Thyroid antibody and thyroid hormone abnormalities could be improved through the course of treatment of anti-NMDAR encephalitis. There were no significant differences between the NTIS and non-NTIS groups in clinical characteristics.Ĭonclusion: Anti-thyroid antibody positivity, abnormality of FT 3, FT 4, or TSH levels and NTIS are frequent in pediatric anti-NMDAR encephalitis. Compared with the ATAb (–) group, the ATAb (+) group had an older onset age, a higher ratio of movement disorders, elevated rate of sleep disorders, increased anti-nuclear antibody positivity rate, and higher ratio of more than one course of intravenous immunoglobulin treatment. Compared with onset, the level of TPOAb and TGAb at relapse remained stable or significantly decreased, respectively. Among 25 cases retested for thyroid function 2 months after the initial test, the respectively decreased FT 3 and FT 4 in 13 and 11 cases on admission returned to normal or closer normal than before TPOAb in eight cases and TGAb in 12 cases were changed from positivity to negativity. Meanwhile, 45.1% of patients were diagnosed with NTIS. A percentage of 62.7% of patients had at least one abnormality in terms of FT 3, free thyroxin (FT 4), or TSH levels. Results: A percentage of 52.9% of patients belonged to the ATAb (+) group, with 26 cases both positive for anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TGAb), and one patient only positive for TPOAb. Methods: We retrospectively analyzed the clinical data of 51 pediatric cases with anti-NMDAR encephalitis hospitalized in Guangzhou Women and Children's Medical Center from August 2016 to 2019. This study aimed to explore thyroid function and ATAbs in pediatric anti-NMDAR encephalitis and their clinical association. Objective: Recent studies found that changes of thyroid antibodies (ATAbs), thyroid hormone, and non-thyroidal illness syndrome (NTIS) characterized by thyroid hormone inactivation with low triiodothyronine and high reverse triiodothyronine followed by suppressed thyroid-stimulating hormone (TSH) in adult anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis were associated with disease severity. Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.Lianfeng Chen † Wenlin Wu † Yang Tian † Yiru Zeng † Chi Hou Haixia Zhu Kelu Zheng Yani Zhang Yuanyuan Gao Bingwei Peng Sida Yang Xiuying Wang Shuyao Ning Yinting Liao Haisheng Lin Kaili Shi Xiaojing Li * Wen-Xiong Chen * ![]()
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