title: Autoimmune thyroiditis associated with neuromyelitis optica (NMO).
abstract: Neuromyelitis optica (NMO or Devic's syndrome) is a rare relapsing demyelinating disease of the central nervous system (CNS) that mainly affects the spinal cord and optic nerves and shares many clinical and radiological features with multiple sclerosis. The association of NMO with other autoimmune diseases was reported, but very few reports described association with autoimmune thyroid disease. Early differentiation between NMO and multiple sclerosis is very important as the natural course and treatment regimens differ significantly. We report a case of a 50-year-old woman who was admitted initially with vomiting, hiccups and paraesthesias but was not diagnosed with NMO and presented with a severe progression of the disease. The patient was also diagnosed to have autoimmune thyroiditis with lymphocytic infiltration of the thyroid which progressed from hyperthyroidism to hypothyroidism. NMO diagnosis was established with seropositivity for NMO-IgG and MRI showing longitudinally extensive spinal cord lesions (3 or more spinal segments). In spite of treatment, the response was poor due to lack of early diagnosis and aggressive immunosuppressant therapy.
authors.affiliation: Columbia Asia Hospital, Bangalore, India.
authors.forename: Sreenivasa Rao
authors.initials: SR
authors.lastname: Sudulagunta
authors.affiliation: K.S. Hegde Medical College, Mangalore, India.
authors.forename: Mahesh Babu
authors.initials: MB
authors.lastname: Sodalagunta
authors.affiliation: Dr.B.R. Ambedkar Medical College, Otolaryngology Department, Bangalore, India.
authors.forename: Hadi
authors.initials: H
authors.lastname: Khorram
authors.affiliation: Baptist Hospital, Bangalore, India.
authors.forename: Mona
authors.initials: M
authors.lastname: Sepehrar
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Jayadevappa
authors.initials: J
authors.lastname: Gonivada
authors.affiliation: Columbia Asia Hospital, Bangalore, India.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Noroozpour
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Nagendra
authors.initials: N
authors.lastname: Prasad
mesh_terms: D057210:Delayed Diagnosis / Q000009:adverse effects; D003951:Diagnostic Errors / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000150:complications* / Q000175:diagnosis; D013967:Thyroiditis, Autoimmune / Q000150:complications* / Q000175:diagnosis
keywords: IgG; autoimmune thyroiditis; neuromyelitis optica (NMO); optic neuritis; transverse myelitis