Autoimmune Alternating Hypo- and Hyperthyroidism in Children

Mathew, Revi P.; Moore, Daniel J.

doi:10.1177/0009922811412583

Cited by 8 publications

(13 citation statements)

References 20 publications

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“…This last option requires frequent thyroid function monitoring to titrate drugs. Mathew & Moore (4) reported two similar cases, in a 5- and an 8-year-old girl in whom an appropriate single drug regimen failed to control thyroid function. In both cases, and considering their age, patients underwent a total thyroidectomy (4).…”

Section: Discussionmentioning

confidence: 94%

“…Mathew & Moore (4) reported two similar cases, in a 5- and an 8-year-old girl in whom an appropriate single drug regimen failed to control thyroid function. In both cases, and considering their age, patients underwent a total thyroidectomy (4). In this case, double therapy briefly controlled thyroid function, with frequent dose adjustment needed.…”

Section: Discussionmentioning

confidence: 94%

“…This type of oscillation in thyroid function is extremely rare, especially in the pediatric age, and is only described in a few case reports in literature (4, 5). Takasu & Matsushita (10) admitted that this fluctuation in thyroid function can be explained by the simultaneous presence of TSAbs and TBAbs in the sera of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…TBAbs are found in a significant number (18.5%) of adult patients with untreated Graves' disease; however, TBAbs-induced hypothryoidism is a very rare condition (4, 5). Some patients may have TBAbs and TSAbs sequentially and evolve from hypo- to hyperthyroidism or vice versa.…”

Section: Introductionmentioning

confidence: 99%

“…In very few adult patients, both antibodies may be present simultaneously, leading to a rapid oscillation in thyroid function as TBAbs or TSAbs become dominant (5). This situation is even more uncommon in pediatric population (4). The TRAbs activity may be estimated in vitro through bioassays.…”

Section: Introductionmentioning

confidence: 99%

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

Martins¹,

Coutinho²,

Jerónimo³

et al. 2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryAlternating between hyper- and hypo-thyroidism may be explained by the simultaneous presence of both types of TSH receptor autoantibodies (TRAbs) – thyroid stimulating autoantibodies (TSAbs) and TSH blocking autoantibodies (TBAbs). It is a very rare condition, particulary in the pediatric age. The clinical state of these patients is determined by the balance between TSAbs and TBAbs and can change over time. Many mechanisms may be involved in fluctuating thyroid function: hormonal supplementation, antithyroid drugs and levels of TSAbs and TBAbs. Frequent dose adjustments are needed in order to achieve euthyroidism. A definitive therapy may be necessary to avoid switches in thyroid function and frequent need of therapeutic changes. We describe an immune-mediated case of oscillating thyroid function in a 13-year-old adolescent. After a short period of levothyroxine treatment, the patient switched to a hyperthyroid state that was only controlled by adding an antithyroid drug.Learning points Autoimmune alternating hypo- and hyper-thyroidism is a highly uncommon condition in the pediatric age.It may be due to the simultaneous presence of both TSAbs and TBAbs, whose activity may be estimated in vitro through bioassays.The clinical state of these patients is determined by the balance between TSAbs and TBAbs and can change over time.The management of this condition is challenging, and three therapeutic options could be considered: I-131 ablation, thyroidectomy or pharmacological treatment (single or double therapy).Therapeutic decisions should be taken according to clinical manifestations and thyroid function tests, independent of the bioassays results.A definitive treatment might be considered due to the frequent switches in thyroid function and the need for close monitoring of pharmacological treatment. A definitive treatment might be considered due to the frequent switches in thyroid function and the need for close monitoring of pharmacological treatment.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Martins¹,

Coutinho²,

Jerónimo³

et al. 2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

View full text Add to dashboard Cite

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Alternating hyperthyroidism and hypothyroidism in Graves’ disease

Wong

Inder

2018

Clinical Case Reports

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Key Clinical MessageSpontaneously oscillating thyroid function in Graves’ disease is a rare phenomenon. Switching between TSH receptor stimulating antibodies (TSAb) and TSH receptor blocking antibodies (TBAb) most likely accounts for presentations of alternating hyperthyroidism and hypothyroidism. To achieve stability of thyroid function, definitive therapy is recommended to remove the pathological thyroid.

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