A series report of autoimmune hypothyroidism associated with Hashimoto's encephalopathy: an under diagnosed clinical entity with good prognosis.
Thyroid dysfunctions may be accompanied by numerous neurological and psychiatric disorders. The most well-known is cognitive impairment and depression in hypothyroid patients, as well as an increased risk of cerebrovascular accidents. A separate, although a rare entity, is Hashimoto's encephalopathy. Unlike encephalopathy associated with other conditions, management in Hashimoto's encephalopathy highly responds to steroid treatment and may be associated with normal thyroid profile at presentation. Hashimoto's encephalopathy, while rare, may have been under-recognised since its clinical presentation overlaps several more common disorders, such as depression, seizures or anxiety. We present two cases of hypothyroidism with peculiar presentation. The first case has rapidly progressive neurological dysfunction, normal thyroid function at presentation, normal MRI finding and responds to steroid treatment. The second case has a subacute progressive neurological deterioration with elevated thyroid-stimulating hormone titre at presentation. Both these cases are known hypothyroidism on regular thyroxin replacement therapy with elevated anti-thyroid peroxidase antibodies. We conclude that Hashimoto's encephalopathy can present with a wide spectrum of neurological illnesses in the setting of hypothyroidism. Thyroid status may vary from hypothyroid, normothyroid to even hyperthyroid. This condition usually has an abnormal electroencephalography (EEG) background and usually responds to high dose steroids.
Department of Medicine, Maulana Azad Medical College, New Delhi, India. drhemantnayak@gmail.com
Hemanta Kumar
HK
Nayak
Mrudul Kumar
MK
Daga
Rakshit
R
Kumar
Sandeep Kumar
SK
Garg
Naresh
N
Kumar
Pankaj Kumar
PK
Mohanty
D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D004569:Electroencephalography; D004660:Encephalitis; D050031:Hashimoto Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging; D011379:Prognosis; D013960:Thyroid Function Tests; D013967:Thyroiditis, Autoimmune; D013972:Thyrotropin / Q000097:blood
D013972:Thyrotropin