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Gene & Protein in Disease Autoimmune thyroid disease in narcolepsy

limbs, causing her to fall down, but would be relieved after the patient’s normal thyroid function, no treatment was
a few seconds; she also experienced sleep fragmentation administered. Only modafinil was prescribed to improve
at night with excessive dreams. At the same time, she was the patient’s sleep symptoms. After a year of follow-up,
surprised to find that her body weight had increased by the patient’s sleep symptoms and thyroid function were
approximately 25 kg within a year. A standard neurological re-evaluated. We found a significant improvement in the
examination and a neuropsychological assessment of patient’s EDS; however, she developed hypothyroidism.
the patient were performed by a neurologist. She scored Otherwise, there was also significant improvement in her
18 points on the epworth sleepiness scale, which was cataplexy attacks. Following a discussion with the patient
used to assess the degree of subjective sleepiness , and and her family members, the patient was started on thyroid
[9]
12 points on the Pittsburgh Sleep Quality Index, suggesting replacement therapy so as to achieve a euthyroid state,
average sleep quality. The magnetic resonance imaging and while still receiving modafinil.
magnetic resonance angiography of her brain were normal. The research protocol of this study was approved by the
She was otherwise well with no significant comorbidity or Research Ethics Committee of Henan Provincial People’s
family history of neurological illness. Given these clues, Hospital, and the participant signed the written informed
polysomnography (PSG) and multiple sleep latency test consent forms.
(MSLT) were performed on the patient to further clarify
the diagnosis. PSG study showed a total sleep time of 3. Discussion
579.5 min, sleep efficiency of 76.5%, and apnea-hypopnea
index of 1.7/h, which can exclude obstructive sleep apnea The previous studies have found that the prevalence rate
(Table 1). Her MSLT showed a mean sleep latency of of immunopathological diseases is higher in patients
0.7 min and four sleep-onset rapid eye movement periods with narcolepsy [8,10,11] . Cataplexy, in particular, is often
(SOREMPs) in five naps without notable sleep paralysis. associated with comorbid immunopathological diseases
[8]
Her cerebrospinal fluid hypocretin-1, measured by associated with narcolepsy . However, to the best of our
enzyme-linked immunosorbent assay, was 71.54 pg/mL. knowledge, this is the first case of narcolepsy with AITD.
In addition, she was found to be HLA-DQB*06:02 positive. According to the ICSD-3 diagnostic criteria for narcolepsy,
According to the International Classification of Sleep this case was not difficult to diagnose. In addition, the
Disorders, 3 edition (ICSD-3), we diagnosed the case as previous studies have also demonstrated that weight
rd
narcolepsy Type 1 (NT1). gain, in particular, is often related to narcolepsy with
cataplexy [12-14] . Impaired feeding behavior, including binge
Laboratory tests for the patient, including complete eating, nocturnal eating, and increased food cravings, may
blood count, renal function, electrolytes, cardiac enzymes, contribute to this phenomenon . In addition, abnormal
[15]
liver enzymes, sex hormones, fasting growth hormone, energy metabolism and reduced spontaneous activity are
autoimmune encephalitis antibody, immunoglobulin, and also important factors that contribute to the altered body
complement tests, were all normal. However, her serum mass index .
[16]
25-hydroxyvitamin D (25(OH)D) level was 12.45 ng/mL
(normal range >20 ng/mL), and her thyroid function test AITD is characterized by the dysfunction of thyroid
[17]
showed abnormally high levels of thyroglobulin antibody tissue by antibody-mediated immune inflammation .
(TgAb) and thyroid peroxidase antibody (TPOAb) TPOAb and TgAb are the main thyroid autoantibodies
(Table 2). Her thyroid gland was normal in texture and that cause thyroid destruction and suppression of
size. Following-up with the patient’s past medical history, function. They are sensitive indicators for the diagnosis
[18]
the patient had not consumed any antithyroid drugs. and prognosis of autoimmune thyroid disease . Elevated
There was also no antecedent history of thyroidectomy, levels of TPOAb and TgAb are early manifestations in
neck radiotherapy, and radioactive iodine ( I) therapy patients with Hashimoto’s thyroiditis (HT) and may have
131
for hyperthyroidism. Based on her medical history and initiated certain pathophysiological changes in the thyroid
laboratory tests, she was diagnosed with AITD. Given gland, albeit the normal thyroid function occasionally.
Table 1. Result of PSG

TST AWN/h WASO SE N1 N2 N3 REM AI PLMI AHI
(min) (%) (%) (%) (%) (%) (%) (event/h) (event/h) (event/h)
Value 579.5 4.0 13.4 76.5 29.2 43.4 11.9 15.5 6.1 0.4 1.7
PSG: Polysomnography; AHI: Apnea-hypopnea index; AI: Arousal index; AWN/h: Awakenings per hour; N1, N2, N3: Standard non-rapid eye
movement sleep stages; PLMI: Periodic limb movement index; REM: Rapid eye movement sleep; REML: Rapid eye movement sleep latency; SE: Sleep
efficiency; TST: Total sleep time; WASO: Wakefulness after sleep onset

Volume 2 Issue 1 (2023) 2 https://doi.org/10.36922/gpd.v2i1.235