AccScience Publishing / GPD / Volume 2 / Issue 1 / DOI: 10.36922/gpd.v2i1.235
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CASE REPORT

Autoimmune thyroid disease in narcolepsy: A case report

Chaofan Geng1 Zhenzhen Yang2 Hongju Zhang1,3*
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1 Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou 450003, China
2 Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou 450003, China
3 Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou 450003, China
Submitted: 25 October 2022 | Accepted: 19 December 2022 | Published: 11 January 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

While the previous studies have discussed the association of narcolepsy with autoimmune diseases, autoimmune thyroid disease (IATD) has rarely been described in patients with narcolepsy. The association of narcolepsy with thyroid disease is intriguing for speculating the causal or coexisting autoimmune disorder. We report a case of narcolepsy Type 1 with IATD, presenting with excessive daytime sleepiness (EDS), cataplexy attacks, and unexplainable weight gain. Oral modafinil and sodium oxybate were used for treatment and prevention. During the 1-year follow-up, the patient’s EDS and cataplexy attacks improved. However, the patient developed hypothyroidism and was subsequently prescribed with thyroid replacement therapy.

Keywords
Autoimmune thyroid disease
Narcolepsy
Mechanism
Autoimmunity
Case report
Funding
No funding was received in drafting this manuscript.
Conflict of interest
The authors have no conflict of interest to declare.
References
[1]

Bassetti CL, Adamantidis A, Burdakov D, et al., 2019, Narcolepsy-clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol, 15(9): 519–539. https://doi.org/10.1038/s41582-019-0226-9

[2]

Postiglione E, Antelmi E, Pizza F, et al., 2018, The clinical spectrum of childhood narcolepsy. Sleep Med Rev, 38: 70–85. https://doi.org/10.1016/j.smrv.2017.04.003

[3]

Luo G, Yogeshwar S, Lin L, et al., 2021, T cell reactivity to regulatory factor X4 in Type 1 narcolepsy. Sci Rep, 11(1): 7841. https://doi.org/10.1038/s41598-021-87481-8

[4]

Andlauer O, Moore HT 4th, Hong SC, et al., 2012, Predictors of hypocretin (orexin) deficiency in narcolepsy without cataplexy. Sleep, 35(9): 1247–1255F. https://doi.org/10.5665/sleep.2080

[5]

Liblau RS, Vassalli A, Seifinejad A, et al., 2015, Hypocretin (orexin) biology and the pathophysiology of narcolepsy with cataplexy. Lancet Neurol, 14(3): 318–328. https://doi.org/10.1016/s1474-4422(14)70218-2

[6]

Kachooei-Mohaghegh-Yaghoobi L, Rezaei-Rad F, Sadeghniiat-Haghighi K, et al., 2020, The impact of the HLA DQB1 gene and amino acids on the development of narcolepsy. Int J Neurosci, 132(7): 706–713. https://doi.org/10.1080/00207454.2020.1835903

[7]

Bourgin P, Zeitzer JM, Mignot E, 2008, CSF hypocretin-1 assessment in sleep and neurological disorders. Lancet Neurol, 7(7): 649–662. https://doi.org/10.1016/s1474-4422(08)70140-6

[8]

Martinez-Orozco FJ, Vicario JL, Villalibre-Valderrey I, et al., 2014, Narcolepsy with cataplexy and comorbid immunopathological diseases. J Sleep Res, 23(4): 414–419. https://doi.org/10.1111/jsr.12143 

[9]

Johns MW, 1991, A new method for measuring daytime sleepiness: The epworth sleepiness scale. Sleep, 14(6): 540–545. https://doi.org/10.1093/sleep/14.6.540

[10]

Peraita-Adrados R, Lammers GJ, De Andres C, et al., 2013, A patient with narcolepsy with cataplexy and multiple sclerosis: Two different diseases that may share pathophysiologic mechanisms? Sleep Med, 14(7): 695–696. https://doi.org/10.1016/j.sleep.2013.03.015

[11]

Ekbom K, 1966, Familial multiple sclerosis associated with narcolepsy. Arch Neurol, 15(4): 337–344. https://doi.org/10.1001/archneur.1966.00470160003001

[12]

Schuld A, Hebebrand J, Geller F, et al., 2000, Increased body-mass index in patients with narcolepsy. Lancet, 355(9211): 1274–1275. https://doi.org/10.1016/s0140-6736(05)74704-8

[13]

Cohen A, Mandrekar J, St Louis EK, et al., 2018, Comorbidities in a community sample of narcolepsy. Sleep Med, 43: 14–18. https://doi.org/10.1016/j.sleep.2017.11.1125

[14]

Poli F, Pizza F, Mignot E, et al., 2013, High prevalence of precocious puberty and obesity in childhood narcolepsy with cataplexy. Sleep, 36(2): 175–181. https://doi.org/10.5665/sleep.2366 

[15]

Chabas D, Foulon C, Gonzalez J, et al., 2007, Eating disorder and metabolism in narcoleptic patients. Sleep, 30(10): 1267–1273.https://doi.org/10.1093/sleep/30.10.1267 

[16]

Zhang M, Thieux M, Inocente CO, et al., 2022, Characterization of rapid weight gain phenotype in children with narcolepsy. CNS Neurosci Ther, 28(6): 829–841. https://doi.org/10.1111/cns.13811

[17]

Huang KH, Tai MC, Lee LC, et al., 2018, Positron emission tomography/computed tomography scan of Vogt-Koyanagi- Harada syndrome with associated autoimmune thyroid disease: A case report and literature review. Medicine (Baltimore), 97(9): e0047. https://doi.org/10.1097/md.0000000000010047

[18]

Radetti G, Gottardi E, Bona G, et al., 2006, The natural history of euthyroid Hashimoto’s thyroiditis in children. J Pediatr, 149(6): 827–832. https://doi.org/10.1016/j.jpeds.2006.08.045

[19]

Umpierrez GE, Latif KA, Murphy MB, et al., 2003, Thyroid dysfunction in patients with Type 1 diabetes: A longitudinal study. Diabetes Care, 26(4): 1181–1185. https://doi.org/10.2337/diacare.26.4.1181

[20]

Wiendl H, Gross CC, Bauer J, et al., 2021, Fundamental mechanistic insights from rare but paradigmatic neuroimmunological diseases. Nat Rev Neurol, 17(7): 433–447. https://doi.org/10.1038/s41582-021-00496-7

[21]

Pedersen NW, Holm A, Kristensen NP, et al., 2019, CD8+ T cells from patients with narcolepsy and healthy controls recognize hypocretin neuron-specific antigens. Nat Commun, 10(1): 837. https://doi.org/10.1038/s41467-019-08774-1

[22]

Mahlios J, De la Herran-Arita AK, Mignot E, 2013, The autoimmune basis of narcolepsy. Curr Opin Neurobiol, 23(5): 767–773. https://doi.org/10.1016/j.conb.2013.04.013

[23]

Wijnans L, Lecomte C, de Vries C, et al., 2013, The incidence of narcolepsy in Europe: Before, during, and after the influenza A(H1N1)pdm09 pandemic and vaccination campaigns. Vaccine, 31(8): 1246–1254. https://doi.org/10.1016/j.vaccine.2012.12.015

[24]

Han F, Lin L, Warby SC, et al., 2011, Narcolepsy onset is seasonal and increased following the 2009 H1N1 pandemic in China. Ann Neurol, 70(3): 410–417. https://doi.org/10.1002/ana.22587 

[25]

Partinen M, Kornum BR, Plazzi G, et al., 2014, Narcolepsy as an autoimmune disease: The role of H1N1 infection and vaccination. Lancet Neurol, 13(6): 600–613. https://doi.org/10.1016/S1474-4422(14)70075-4

[26]

Aran A, Lin L, Nevsimalova S, et al., 2009, Elevated anti-streptococcal antibodies in patients with recent narcolepsy onset. Sleep, 32(8): 979–983. https://doi.org/10.1093/sleep/32.8.979 

[27]

Mignot E, Lin L, Rogers W, et al., 2001, Complex HLA-DR and-DQ interactions confer risk of narcolepsy-cataplexy in three ethnic groups. Am J Hum Genet, 68(3): 686–699. https://doi.org/10.1086/318799

[28]

Mahoney CE, Cogswell A, Koralnik IJ, et al., 2019, The neurobiological basis of narcolepsy. Nat Rev Neurosci, 20(2): 83–93. https://doi.org/10.1038/s41583-018-0097-x

[29]

Li L, Liu S, Yu J, 2020, Autoimmune thyroid disease and Type 1 diabetes mellitus: Same pathogenesis; new perspective? Ther Adv Endocrinol Metab, 11: 2042018820958329. https://doi.org/10.1177/2042018820958329

[30]

Bellan M, Andreoli L, Mele C, et al., 2020, Pathophysiological role and therapeutic implications of Vitamin D in autoimmunity: Focus on chronic autoimmune diseases. Nutrients, 12(3): 789. https://doi.org/10.3390/nu12030789

[31]

Dauvilliers Y, Evangelista E, Lopez R, et al., 2017, Vitamin D deficiency in Type 1 narcolepsy: A reappraisal. Sleep Med, 29: 1–6. https://doi.org/10.1016/j.sleep.2016.05.008

[32]

Carlander B, Puech-Cathala AM, Jaussent I, et al., 2011, Low Vitamin D in narcolepsy with cataplexy. PLoS One, 6(5): e20433. https://doi.org/10.1371/journal.pone.0020433

[33]

Wang J, Lv S, Chen G, et al., 2015, Meta-analysis of the association between Vitamin D and autoimmune thyroid disease. Nutrients, 7(4): 2485–2498. https://doi.org/10.3390/nu7042485

[34]

Alamo A, Condorelli RA, La Vignera S, et al., 2019, Autoimmune thyroid disease following treatment with alemtuzumab for multiple sclerosis. Int J Immunopathol Pharmacol, 33: 2058738419843690. https://doi.org/10.1177/2058738419843690 

[35]

Zhao R, Zhang W, Ma C, et al., 2021, Immunomodulatory function of Vitamin D and its role in autoimmune thyroid disease. Front Immunol, 12: 574967. https://doi.org/10.3389/fimmu.2021.574967 

[36]

Bishop EL, Ismailova A, Dimeloe S, et al., 2021, Vitamin D and immune regulation: Antibacterial, antiviral, anti-inflammatory. JBMR Plus, 5(1): e10405. https://doi.org/10.1002/jbm4.10405

[37]

Mohammadi S, Mayeli M, Saghazadeh A, et al., 2020, Cytokines in narcolepsy: A systematic review and meta-analysis. Cytokine, 131: 155103. https://doi.org/10.1016/j.cyto.2020.155103

[38]

Dauvilliers Y, Jaussent I, Lecendreux M, et al., 2014, Cerebrospinal fluid and serum cytokine profiles in narcolepsy with cataplexy: A case-control study. Brain Behav Immun, 37: 260–266. https://doi.org/10.1016/j.bbi.2013.12.019

[39]

Mikos H, Mikos M, Obara-Moszynska M, et al., 2014, The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease (AITD). Endokrynol Pol, 65(2): 150–155. https://doi.org/10.5603/ep.2014.0021 

[40]

Ganesh BB, Bhattacharya P, Gopisetty A, et al., 2011, Role of cytokines in the pathogenesis and suppression of thyroid autoimmunity. J Interferon Cytokine Res, 31(10): 721–731. https://doi.org/10.1089/jir.2011.0049

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Gene & Protein in Disease, Electronic ISSN: 2811-003X Published by AccScience Publishing