Autoimmune thyroiditis in a child with steroid-dependent nephrotic syndrome

Autoimmune thyroiditis is rarely described in association with nephrotic syndrome. Herein we report a girl who developed autoimmune thyroiditis insidiously during the course of minimal change nephrotic syndrome. She was streroid-sensitive, but developed severe steroid dependency and did not respond to cyclophosphamide therapy. She went into stable remission with levamisole. Five months after introduction of levamisole a mild goiter was found on systematic examination at school. The diagnosis of autoimmune thyroiditis was established with typical ultrasound appearance of the thyroid gland along with significant titers of antithyroid antibodies. It is very unlikely that levamisole was responsible for thyroiditis because experimental animal administration of high doses of levamisole inhibited lymphocyte infiltration of the thyroid. Since levamisole has had a beneficial effect on the nephrotic syndrome in our patient we decided to continue the treatment. She has been receiving levamisole for 3 years, and no adverse effects have been observed during the treatment period.