Ann Pediatr Endocrinol Metab.  2013 Dec;18(4):214-217. 10.6065/apem.2013.18.4.214.

Nongoitrous autoimmune thyroiditis with facial palsy

• Lee HJ
• Kim JK

• KMID: 2266358
• DOI: http://doi.org/10.6065/apem.2013.18.4.214

Abstract

We report a case of severe hypothyroidism with nongoitrous, autoimmune thyroiditis and pituitary hyperplasia in a 13-year-old boy, who presented with sudden palsy on the left side of his face. Prednisolone and antiviral medication was administered. However, the facial palsy did not improve completely. The medications were replaced with thyroxine, and the facial palsy recovered. Endocrinological testing showed severe hypothyroidism as follows: thyroid stimulating hormone (TSH) level >100 microIU/mL, T4 of 1.04 microg/dL, T3 of 0.31 ng/mL, and free T4 of 0.07 ng/dL. Level of serum antithyroid peroxidase antibodies was 1,933.39 IU/mL, and that of antithyroglobulin antibodies was 848.16 IU/mL. Level of TSH receptor antibodies was >40 IU/L. Bioassay result for TSH receptor stimulating antibodies was negative. Thyroid sonography revealed no increase in the size or vascularity of the bilateral gland. Thyroid scintigraphy with 99mTc showed decreased uptake, and magnetic resonance imaging demonstrated an enlarged pituitary gland.

Keyword

Autoimmune thyroiditis; Facial palsy; Hypothyroidism

MeSH Terms

Adolescent
Antibodies
Biological Assay
Facial Paralysis*
Humans
Hyperplasia
Hypothyroidism
Magnetic Resonance Imaging
Male
Paralysis
Peroxidase
Pituitary Gland
Prednisolone
Radionuclide Imaging
Receptors, Thyrotropin
Thyroid Gland
Thyroiditis, Autoimmune*
Thyrotropin
Thyroxine
Antibodies
Peroxidase
Prednisolone
Receptors, Thyrotropin
Thyrotropin
Thyroxine

Figure

• 

  Fig. 1 Thyroid sonography shows a heterogenous internal structure without an increase in size or vascularity of the bilateral gland.

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  Fig. 2 Thyroid scintigraphy with 99mTc shows a substantial decrease in uptake in both lobes.

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  Fig. 3 Magnetic resonance imaging demonstrates an enlarged pituitary gland, with upward convexity, 13.0 mm in height and 8 mm at the transverse diameter.

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