Organ Specific Autoimmunity in Thyroid Disorders; A Case Presentation of Thyroid Eye Disease and Monophasic CNS Manifestation

Idiopathic inflammatory diseases (IIDs) of the central nervous system (CNS) comprise a broad spectrum of disorders which may be differentiated according to the clinical presentation, neuroimaging and pathological findings. Systemic autoimmune diseases including vasculitis, Beh et’s disease, antiphospholipid syndrome and thyroiditis may also present with CNS manifestations and MRI findings of hyperintense lesions in the CNS. Graves’ disease is an autoimmune thyroid disease that might involve CNS and orbits in the setting of hyperthyroid, hypothyroid or euthyroid state. Findings of orbital involvement are proptosis, dry eyes, strabismus, and optic neuropathy. Recent literature has also proposed that altered thyroid function homeostasis might trigger subsequent demyelination. Here, we report a patient who presented with a hyperintense pontine lesion and ocular findings in the setting of hyperthyroid state. We aim to further discuss the underlying mechanisms leading to this presentation. (Arc-hi-ves of Neu-ropsy-chi-atry 2011;48: 274-6)