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IP Indian Journal of Neurosciences


Relapsing myelitis in patients with anti thyroid antibodies –Steroids may not be enough


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Article Type : Case Report

Author Details: Khichar Shubhakaran*,Amita Bhargava,Arvind Lakesar,Inder Puri,Akanksha Choudhary

Volume : 5

Issue : 2

Online ISSN : 2581-916X

Print ISSN : 2581-8236

Article First Page : 89

Article End Page : 90


Abstract

Autoimmune thyroiditis has been seen to be associated with other autoimmune neurological disorders. More over biopsy studies of patients with steroid responsive encephalopathy has shown that antithyroid antibodies (anti thyroid peroxidase-TPO antibodies) can lead to central nervous system demyelination. We are reporting two such cases. A 32 year female presented with longitudinally extensive transverse myelitis(LETM) with negative workup for other demyelinating and autoimmune diseases, and positive for anti TPO antibody. She was started with steroids and azathioprine and recovered completely over one month period, stopped treatment herself after 5 months, had relapse of myelitis and was put on immunosuppressive treatment, showing improvement. The second patient a 52 year female had recurrent attack of LETM with negative workup for other causes of LETM except positive anti TPO antibody. In her first attack she was given only steroids pulse. After relapse she was treated with steroids and cyclophosphamide pulse, and patient remained relapse free thereafter. So it suggests that in myelitis patients associated with anti TPO antibody steroids alone may not be sufficient and, such patients require long term immunosuppression. So anti TPO antibody may predict recurrence and may be considered an independent marker for relapsing disease though it require further studies.

Keywords: Myelitis, Anti-TPO, antibodies, Recurrent myelitis, Longitudinally extensive transverse myelitis (LETM).

Doi No:-10.18231/j.ijn.2019.012