Anti-Thyroid Peroxidase/Anti-Thyroglobulin Antibody-Related Neurologic Disorder Responsive to Steroids Presenting with Pure Acute Onset Chorea

Tremor Other Hyperkinet Mov (N Y). 2020 Jul 8:10:19. doi: 10.5334/tohm.175.

Abstract

Background: Pure acute onset chorea without encephalopathy has rarely been reported in anti-thyroid peroxidase (anti-TPO)/anti-thyroglobulin (anti-TG) antibody-related neurologic disorders responsive to steroids (ATANDS).

Case report: We report a 16-year-old female who presented with acute chorea without encephalopathy. Anti-TPO antibodies were found to be strongly positive (>1200 IU/ml) along with anti-thyroglobulin and anti-thyroid stimulating hormone receptor antibodies. After pulse intravenous methylprednisolone therapy (1 g/day for five consecutive days), all the movements seized, and she was discharged with oral prednisolone 30 mg/day with gradual tapering over next three months. After one year of follow-up, she is stable, drug-free, and never had any other problems.

Discussion: Anti-thyroid antibodies testing should be included in routine/conventional panel that is done for elucidating causes of chorea as ATANDS can be easily missed and is treatable with widely available, relatively low-cost drugs like steroids with a promising outcome.

Keywords: Anti-thyroglobulin antibodies; Anti-thyroid peroxidase antibodies; Anti-thyroid peroxidase/anti-thyroglobulin antibody-related neurologic disorders responsive to steroids; Autoimmune; Chorea; Movement Disorders; Review; Steroid-responsive encephalopathy associated with autoimmune thyroiditis.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Autoantigens / immunology*
  • Autoimmune Diseases of the Nervous System / complications
  • Autoimmune Diseases of the Nervous System / diagnosis
  • Autoimmune Diseases of the Nervous System / drug therapy
  • Autoimmune Diseases of the Nervous System / immunology*
  • Chorea / diagnosis
  • Chorea / drug therapy
  • Chorea / etiology
  • Chorea / immunology*
  • Female
  • Humans
  • Iodide Peroxidase / immunology*
  • Iron-Binding Proteins / immunology*
  • Methylprednisolone / pharmacology
  • Steroids / administration & dosage
  • Steroids / pharmacology*
  • Thyroglobulin / immunology*

Substances

  • Autoantigens
  • Iron-Binding Proteins
  • Steroids
  • TG protein, human
  • Thyroglobulin
  • TPO protein, human
  • Iodide Peroxidase
  • Methylprednisolone

Grants and funding

This research was supported by FEDER funds. R. Ghosh, S. Chatterjee, S. Dubey, A. Pandit, B. Kanti Ray report no relevant disclosures. J. Benito-León is supported by the National Institutes of Health, Bethesda, MD, USA (NINDS #R01 NS39422), European Commission (grant ICT-2011-287739, NeuroTREMOR), the Ministry of Economy and Competitiveness (grant RTC-2015-3967-1, NetMD—platform for the tracking of movement disorder), and the Spanish Health Research Agency (grant FIS PI12/01602 and grant FIS PI16/00451).