Abstract
Steroid responsive encephalopathy with autoimmune thyroiditis (SREAT), a rare disorder in individuals of all age groups, including children, is characterized by high titers of anti-thyroid peroxidase antibodies. The present report concerns a previously healthy 12-y-old boy who presented with motor tics. The patient underwent an extensive work-up to identify the underlying etiologies and risk factors predisposing him to tic disorder. Based on the clinical and laboratory results, a diagnosis of SREAT was made. Although some studies have reported associated behavioral and cognitive changes, myoclonus, seizures, pyramidal tract dysfunction, psychosis, and coma. The authors describe a case of tic disorder, probably due to SREAT, as well as its course of treatment.
References
Castillo P, Woodruff B, Caselli R, Vernino S, Lucchinetti C, Swanson J, et al. Steroid-responsive encephalopathy associated with autoimmune thyroiditis. Arch Neurol. 2006;63:197–202.
Snider LA, Seligman LD, Ketchen BR, Levitt SJ, Bates LR, Garvey MA, et al. Tics and problem behaviors in schoolchildren: prevalence, characterization, and associations. Pediatrics. 2002;110:331–6.
Banerjee TK, Hazra A, Biswas A, Ray J, Roy T, Raut DK, et al. Neurological disorders in children and adolescents. Indian J Pediatr. 2009;76:139–46.
Mejia NI, Jankovic J. Secondary tics and tourettism. Rev Bras Psiquiatr. 2005;27:11–7.
Snider LA, Lougee L, Slattery M, Grant P, Swedo SE. Antibiotic prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders. Biol Psychiatry. 2005;57:788–92.
Erol I, Saygi S, Alehan F. Hashimoto’s encephalopathy in children and adolescents. Pediatr Neurol. 2011;45:420–2.
Kothbauer-Margreiter I, Sturzenegger M, Komor J, Baumgartner R, Hess CW. Encephalopathy associated with Hashimoto thyroiditis: diagnosis and treatment. J Neurol. 1996;243:585–93.
Chong JY, Rowland LP, Utiger RD. Hashimoto encephalopathy: syndrome or myth? Arch Neurol. 2003;60:164–71.
Ray M, Kothur K, Padhy SK, Saran P. Hashimoto’s encephalopathy in an adolescent boy. Indian J Pediatr. 2007;74:492–4.
Watemberg N, Greenstein D, Levine A. Encephalopathy associated with Hashimoto thyroiditis: pediatric perspective. J Child Neurol. 2006;21:1–5.
Arya R, Anand V, Chansoria M. Hashimoto encephalopathy presenting as progressive myoclonus epilepsy syndrome. Eur J Paediatr Neurol. 2013;17:102–4.
Mocellin R, Lubman DI, Lloyd J, Tomlinson EB, Velakoulis D. Reversible dementia with psychosis: Hashimoto’s encephalopathy. Psychiatry Clin Neurosci. 2006;60:761–3.
Nieuwenhuis L, Santens P, Vanwalleghem P, Boon P. Subacute Hashimoto’s encephalopathy, treated with plasmapheresis. Acta Neurol Belg. 2004;104:80–3.
Jacob S, Rajabally YA. Hashimoto’s encephalopathy: steroid resistance and response to intravenous immunoglobulins. J Neurol Neurosurg Psychiatry. 2005;76:455–6.
Contributions
SS: Wrote and edited the manuscript; IE and YO: Involoved in patient care, including administration of medication and routine clinical follow- up; IE: Involved in manuscript preparation and edited at all stages along with SS; IE will act as guarantor for this paper.
Conflict of Interest
None.
Role of Funding Source
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Saygi, S., Ozkale, Y. & Erol, I. Tic Disorder Probably Associated with Steroid Responsive Encephalopathy with Autoimmune Thyroiditis (SREAT). Indian J Pediatr 81, 1105–1107 (2014). https://doi.org/10.1007/s12098-014-1374-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-014-1374-y