Central nervous system demyelination associated with anti-thyroid peroxidase antibodies: Insights from two cases and a literature review

Central nervous system (CNS) demyelination, typically associated with autoimmune disorders like multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD), has recently been reported in association with elevated anti-thyroid peroxidase (anti-TPO) antibodies. This case report describes two patients who presented with demyelinating CNS lesions and elevated anti-TPO antibody levels, emphasizing the potential role of thyroid autoimmunity in CNS pathology. The cases are noteworthy due to their rarity and the comprehensive exclusion of other demyelinating conditions. They add to the limited body of evidence supporting the association between anti-TPO antibodies and CNS demyelination and emphasize the importance of considering Autoimmune Thyroid Disorder (ATD) in the differential diagnosis of demyelinating disorders. Further research is needed to elucidate the mechanisms by which anti-TPO antibodies might be associated with CNS demyelination. Prospective studies with larger cohorts could clarify the prevalence and significance of thyroid autoimmunity in demyelinating diseases and its potential role as a therapeutic target. These insights emphasize the importance of recognizing autoimmune thyroiditis as a potential contributor to CNS demyelination and the need for heightened awareness among clinicians when evaluating atypical demyelinating cases. • Two rare instances, involving CNS demyelination linked to anti-TPO antibodies, highlight the intricate relationship between autoimmune thyroid disorder and CNS pathology. • While evaluating central demyelinating disorders, anti-TPO antibody levels are essential, particularly when associated with thyroid dysfunction. • To establish the pathophysiology and relationship between autoimmune thyroid disorder and CNS demyelination, further study is required.