Hashimoto’s Thyroiditis Presents as an Acute Encephalopathy: A Case Report of Unusual Presentation

Abstract

Hashimoto's thyroiditis is the most common thyroid disorder in the United States. Hashimoto encephalopathy is a rare presentation of Hashimoto's thyroiditis that is frequently misdiagnosed.We present the case of a 71-year-old female who had normal mental status at baseline. She presented with acute alteration in mental status. Further evaluation with brain MRI showed a hyperintense signal in the bilateral centrum. Spinal fluid analysis revealed elevated protein. Thyroid peroxidase (TPO) antibody was elevated at 59.7 and TSH was elevated at 4.9. Her mental status improved dramatically after treatment with steroids and levothyroxine. This diagnosis should be suspected when the patient develops acute encephalopathy with positive serum thyroid antibody settings with a complete return to normal mental status after treatment with steroids.

The use of intravenous immunoglobulin in the treatment of Hashimoto’s encephalopathy: case based review

“…Corticosteroid therapy is the treatment of choice, HE being also called “steroid responsive encephalopathy associated with autoimmune thyroiditis” (SREAT) ( 77 ). Treatment is generally initiated with methylprednisolone 500–1,000 mg intravenous for 3–7 days followed by oral prednisone 1–2 mg/kg/day, with a gradual tapering of steroid dose after the desired result is achieved ( 78 ). Depending on the case, corticosteroid therapy duration can vary from months to years ( 79 ).…”

Panorama da Tireoidite de Hashimoto: bases patogênicas, diagnósticas e terapêuticas

“…A Tireoidite de Hashimoto (TH) é uma patologia autoimune que se apresenta pela manifestações de autoanticorpos que provocam lesões nos tecidos tireodianas, resultando em sua hipofunção (Khatib et al, 2022). Na HT, há o comprometimento das células foliculares tireoidianas pela ação dos autoanticorpos dirigidos contra o receptor do TSH, inibindo a funcionalidade celular e corroborando para a hipofunção da glândula (Nishida, 2020).…”

Hashimoto’s encephalopathy: an endocrinological point of view

“…The first-line pharmacological treatment involves the administration of high-dose corticosteroids, although there are no specific guidelines regarding dose and duration. A commonly used regimen is the use of intravenous methylprednisolone at a dose of 500–1000 mg for a week, followed by oral prednisone at a dose of 1–2 mg/kg/day for six to eight weeks, with a gradual tapering of the steroid dose after recovery ( 34 ).…”