Abstract: MON 048

Graves’ Disease Neuropsychiatric Manifestations: Unusual Presentation in a 12 Year-Old Boy

Presenter: Fernanda Sousa Cardoso Lopes


Abstract


Authors: Fernanda S C Lopes*1, Renata S De Oliveira1, Delia Braz2, Laís L Oliveira21Department of Pediatrics. Brasilia University Hospital. University of Brasilia School of Medicine; 2Pediatric Endocrinology Graduation Program. University of Brasilia School of Medicine

Abstract
Introduction: Graves’ Disease Is a Rare Condition Among Pediatric Patients and Co-Morbid Psychosis Have Been Seldom Described.

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Authors: Fernanda S C Lopes*1, Renata S De Oliveira1, Delia Braz2, Laís L Oliveira21Department of Pediatrics. Brasilia University Hospital. University of Brasilia School of Medicine; 2Pediatric Endocrinology Graduation Program. University of Brasilia School of Medicine

Abstract
Introduction: Graves’ Disease Is a Rare Condition Among Pediatric Patients and Co-Morbid Psychosis Have Been Seldom Described.

Clinical Case: We Report on a Twelve-Year-Old Boy Who Presented a Previous 5-Month Period of Irritability, Diarrhea, Weigh Loss, Tremors, Insomnia, Behavior Changes and Headaches. after Beginning with Visual and Hearing Hallucinations, Suicidal Behavior and Depression He Was Referred to the Pediatric Emergency Department and Put into Inpatient Care for Investigation. He Was Diagnosed with Graves Disease (TSH < 0.008 mIU/L; FT4: 7.77 mcg/dL; anti-TSH receptor antibody -TRAb: 34.67 IU/L), and Also Tested Positive for Anti-Transglutaminase-IgA –Ttg: 37.8 UI and Anti-Endomysial IgA Antibodies –EMA: 2+/4+. Intestinal Biopsy Was Not Performed. Thyroid Ultrasound Showed an Enlarged Thyroid with Heterogeneous Echogenicity and Intense Vascularity. It Was Started Methimazole -Mmz (0.75 mg/kg/day); Propranolol (2 mg/kg/day) and Risperidone (0.5 mg/day). a Gluten-Free Diet Was Achieved for Only 2 Months, but Ttg Levels and EMA Evaluation Turned Negative throughout the 2-Year Follow-up. Hyperthyroidism Was Controlled, but Two Years after Diagnosis He Keeps Elevated Trab Levels (20.34 IU/L). Psychiatric Symptoms Were Attenuated, Therapy Was Changed to Fluoxetine, but He Maintained Sporadic Episodes of Hallucinations, Behavior Change and Depressive Behavior. Currently He Receives Quietiapine (25 mg/day) and Venlafaxine (150 mg/day) and Still Presents Mild to Moderate Depressive Status. Even after Reintroduction of Gluten, No More Gluten Sensitivity Manifestations Were Referred. Although Ttg Elevated Levels Have Been Described in Some Neurologic Conditions, EMA Presents High Sensitivity and Specificity for Celiac Disease.
Conclusion: Graves’ Psychosis Have Been Described in Adult Patients, with Mean Ages Between 40-50 Years and a Higher Prevalence Among Women. There Are Also Reports on Adults Recovering from Neurologic and Psychiatric Manifestations Following Gluten Withdrawal from Diet. Nevertheless, Graves’ and Celiac Disease or Gluten Sensitivity Psychosis Is Not Common in Pediatric Patients, with a Few Cases Described. One Hypothesis for This Case Would be That This Adolescent’s Graves’ Psychiatric Manifestations Have Been Triggered and It Is Being Kept By an Interplay Between the Coexistence of the Anti-Thyroid Autoimmunity and Gluten Ingestion

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