An 85-year-old Case with Hashimoto’s Encephalopathy, Showing spontaneous Complete Remission

Case Details

Disease Location

Thyroid

Personal Characteristics

85 -year-old male japanese farmer no psychiatric history

Clinical Characteristics

Abrupatiently developed personality change and cognitive impairment while being treated for chronic thyroiditis hashimoto's encephalopathy (he) which is associated with thyroid autoimmunity (onset at 85) no fever or headache, graduate became unable to work during the next two weeks due to progressive worsening of cognitive impairment with two sudden-onset attacks of right hemiplegia or speech disturbance persisting for approx. 10 mins. 1 month after onset, physical exam showed no abnormal finding in chest or abdomen, he was in a confusional state with poor concentration, postural fine tremor and myoclonus with no paresis in the extremities predominantly on the right side, and no signs of meningeal irritation on the hasegawa's dementia scale (hds-r) he scored 13/30 (normal level is higher than 20/30) no involvement in either cranial nerves or sensation, tendon reflexes were normal with negative babinski's sign on both sides. No abnormal findings in routine lab data except mildly elevated level of thyroid-stimulating hormones (tsh) 10.86 µu/ml, antithyroid peroxidase antibody was within normal limits, but antithyearsoglobulin antibody (tgab) was elevated 29,043 iu/ml. Autoantibody against the amino (nh2) terminal region of a-enolase (nae) could be detected in the serum and anti-nuclear antibody was negative csf fluid shoed normocytosis and increased levels of total protein (88mg/dl) and tgab (579.0 iu/ml) with negative cytology and bacterial culture. IGG index in csf was within normal limits no abnormal findings on MRI, spect or eeg--MRI demonstrated no significant stenosis in any branch of main cerebral arteries

Remission Characteristics

After admission, cognitive impairment and involuntary movement gradually improved with only the treatment from l-thyearsoxine and eventually disappeared with normalization of the hds-r in approx. 2 weeks. Tsh showed no alterations, tgab in serum increased after admission while the tgab in csf decreased in conjunction with the disappearance of neuropsychological symptoms completely recovered with no neurological sequelae and was discharged from the hospital 3 weeks after admission no relapse in neurological condition for 1 year to date complete sr of he approx. 6 weeks afer onset

Treatment & Mechanisms

Proposed Remission Mechanisms

Corticosteroids has been proposed efficacious for he

Clinical Treatment

125µg/day of l-thyearsoxine for chronic thyroiditis

Non-Clinical Treatment

None reported