Endocrine Abstracts

Introduction: There is an association between Moyamoya syndrome and Graves’ disease, described primarily in Asian populations. We report a case of Moyamoya vasculopthy with stroke and hypertension associated with graves’ disease in a 15-year-old Tunisian girl.

Observation: A 15-year-old girl diagnosed with Moyamoya vasculopathy was referred to the endocrinology department for hyperthyroidism. The patient had a history of recurrent stroke and hypertension since 2 years-old. She complained of palpitations, weight loss and tremors, bilateral exophthalmia and floppy eyelid syndrome. Physical examination showed bilateral palpebral edema, bilateral exophthalmia and complete eyelid closure. Laboratory investigations showed high level free T4= 38,8 pmol/l (12-22), low TSH <0.05 mUI/I (0,4-4) and high level of TSH receptor antibodies: 35 UI/ml (<5). Thyroid ultrasound revealed an hypoechoic, hypervascular goiter without nodules. Thyroid scintigraphy showed intense and homogeneous uptake. Orbital and brain MRI showed bifrontal anoxic-ischemic lesions with left wallerian degeneration associated with inflammatory myopathy of the right lower oculomotor muscle. The diagnosis of graves’ disease was confirmed. The patient was treated with methimazole leading to clinical and biological euthyroidism after 8 months treatment.

Conclusion: This is the first case of Moyamoya disease coexisting with graves’ diesease in a tunisian patient. The pathogenesis and the prognosis of hyperthyroidism and specially Graves’ ophtalmopathy are still unknown.