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Assignment:
An 11-year-old girl, with no previous complaints, presented with behavioral and cognitive changes, muscle weakness and a chronic frontal headache for the last 12 months. Her previous medical history and family history were unremarkable. Her physical and neurological examinations were also normal. Laboratory examinations showed that complete blood count, viral markers, toxic compounds, biochemical analyses, as well as collagen disease screening, were within normal limits. Magnetic resonance imaging and EEG were normal. Thyroid function tests produced normal results. High levels of antithyroid antibodies were present, with AMA 55.9 U/ml (normal 0-9 U/ml), TgAb 307 U/ml (normal 0-4U/ml), and TPOAb 64 IU/ml (normal <34 IU/ml). Thyroid ultrasound was normal. She was treated with Intravenous methylprednisolone (IVMP: 20 mg/kg/day) for the first 3 days and then prednisone 1 mg/kg daily. Her neurological symptoms improved dramatically and prednisone was gradually withdrawn within three months.
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