title: Hashimoto's encephalopathy: an unusual cause of seizures in the intensive care unit.
abstract: OBJECTIVE
  To present a case study of Hashimoto's encephalopathy.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Paediatric Intensive Care Unit, Nottingham University Hospital, UK.
  
  
  METHODS
  Two adolescent females presented with encephalopathy and raised venous lactate. Both had subtle signs of neurocognitive deterioration before initial presentation. Extensive investigation revealed elevated antithyroid antibody titer, suggesting Hashimoto's encephalopathy.
  
  
  METHODS
  Steroid administration.
  
  
  RESULTS
  Symptoms rapidly resolved in both cases after steroid treatment.
  
  
  CONCLUSIONS
  Hashimoto's encephalopathy should be considered in cases of unexplained encephalopathy presenting to the intensive care unit. Teenage girls with an antecedent history suggestive of thyroid disease or progressive cognitive decline warrant special attention. Antithyroid antibody titers should be measured even if standard thyroid function tests are normal. Although the etiology is unknown, prompt steroid responsiveness suggests an inflammatory or autoimmune disorder, and patients should be treated accordingly.
authors.affiliation: Paediatric Intensive Care Unit, University Hospital, Queen's Medical Centre, Nottingham, United Kingdom.
authors.forename: Simon E
authors.initials: SE
authors.lastname: Janes
authors.forename: B
authors.initials: B
authors.lastname: Santosh
authors.forename: David
authors.initials: D
authors.lastname: Thomas
authors.forename: Harish
authors.initials: H
authors.lastname: Vyas
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D001927:Brain Diseases / Q000150:complications* / Q000175:diagnosis; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015278:Intensive Care Units, Pediatric; D019344:Lactic Acid / Q000097:blood; D008775:Methylprednisolone / Q000627:therapeutic use; D012640:Seizures / Q000188:drug therapy / Q000209:etiology*; D013967:Thyroiditis, Autoimmune / Q000150:complications* / Q000175:diagnosis / Q000276:immunology
chemical_list: D001323:Autoantibodies; D005938:Glucocorticoids; C056626:thyroid microsomal antibodies; D019344:Lactic Acid; D008775:Methylprednisolone