thyroid complication

    
      Re: thyroid complication
    


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Posted by CCF Neurology MD on September 27, 1997 at 21:01:01:

In Reply to: thyroid complication posted by Peggy on September 24, 1997 at 10:58:36:

: My 10 year old daughter was diagnosed with Hashimoto's Disease having it in excess of two years  with a TSH of 630 in May. It's September now and her TSH is now 22.75.  Her Synthroid was increased from 50 to 75 micrograms/day in August.  Last week she was in ER and had to have a spinal tap to relieve the pressure which was 37 (18-22 is normal).  She had a clean cat scan.  She'd been having severe headaches, nausea and eye pain.  She has papellidemia.  The swelling has gone down but is not gone. Still having some headache pain, but not nearly as severe and no nausea yet  Until she sees her specialist in a week or so, she's back to the 50 microgram level.  Will this go away as her body adjusts to the medicine which will still need increasing?  Is this as rare as I'm told?  Are there meds she can take to relieve the pressure in the brain and optic nerve?  If so, how long before she needs to be taking them? How long before she would sustain permanent damage?
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Dear Peggy:
Your daughter probably has what is called pseudotumor cerebri (PTC) or benign intracranial hypertension. Despite the latter term, the condition is not really benign. The most important complication is loss of visual acuity and shrinking of visual fields, which can potentially even result in blindness with time. It is critical that your daughter very regularly see an ophthalmologist, preferably a neuro-ophthalmologist, who can closely monitor visual function, and appropriately guide treatment. The cause of PTC in most cases is not known, although it tends to occur more frequently in obese women of young to middle age, often with hormonal (menstrual) disturbances. An association of PTC with a wide range of disorders is described in the literature. These include thyroid disease, thyroid replacement, steroid withdrawal, excess of vitamin A and D, auto-immune disease, and various others. Repeated spinal taps are an effective temporizing measure for treatment, but are not curative. Other treatments are usually required, and include medications such as acetazolamide (Diamox), and oral steroids. Some patients are candidates for neurosurgical drainage procedures. Eye damage can be prevented by a fenestrating surgery on the optic nerve sheaths in some resistant cases.
The bottom line is that as serious and pro-active approach needs to be adopted by doctors as well as patients as far as PTC is concerned.
Neither PTC nor Hashimoto's thyroiditis are rare, but their association probably is. I feel each condition needs to be individually addressed, more or less.
Another fact you should be aware of is that Hashimoto's thyroiditis is occasionally associated with very serious brain complications such as strokes, seizures, and encephalopathy. It is unlikely, from your story, that your daughter currently suffers from this set of complications.
Your daughter needs to be closely followed by a pediatric neurologist (and possibly neurosurgeon), a neuro-ophthalmologist, and a pediatric endocrinologist, preferably in an academic tertiary-care setting. If you live near Cleveland, the Cleveland Clinic is one such place. The number to call for appointments is [phone]