Recurrent Hashimoto’s Encephalopathy, Showing spontaneous Remission: A Case report

Case Details

Disease Location

Thyroid

Personal Characteristics

69 -year-old asian male university education no previous psychiatric history

Clinical Characteristics

Hasimoto's encephalopathy (he) associated with hashimoto's thyroiditis (ht) in 2009 went to the hospital with decreased mentality, cognitive impairment, dysarthria and gait disturbance, his wife couldn't understand his speech and he couldn't dress himself physical showed no abnormal findings in chest or abdomen, neurologic exam revealed memory impairment, dysarthria, myoclonus with no paresis in the extremities, gait disturbance and no signs of meningeal irritation. No involvement was seen in either cranial nevers or sensations deep tendon reflex were normal with negative babinski's on both sides. No abnormal findings in routine lab work including hematology, urinalysis, and blood work. Thyroid function showed free t3 3.06 pmol/l, free t4 15.70 pmol/l, tsh 7.6 miu/l, anti-thyroid peroxidase antibody and anti-thyearsoglobulin antibody were markedly elevated (>1,000 iu/ml) MRI and eeg found no abnormalities, mr angiography showed no significant stenosis in any main cerebral arteries thyroid ultrasound revealed diffuse glandular enlargement with a homogeneous but course parenchymal echo texture and multiple discrete hypoechoic micronodules were seen 7 months after the initial admission, symptoms returned (decreased mentality, cog impairment, dysarthria, and gait disturbance) routine lab data, radiological exams and eeg were showed no abnormalities. Thyroid tests demonstrated free t3 2.39 pg/ml, free t4 0.87 ng/dl, tsh 24.17 miu/l. Tpo-ab and tgab were elevated (>1,000 iu/ml) serology, cultures and diagnostic imaging didn't indicate infection, collagen disease or vitamin deficiency. Esr and crp were normal, anca, anti-DNA, and ana were negative. Biochemical results showed aminotranserases, blood glucose, serum creatinine, serum electrolytes and vit b-12 were normal. Mmse revealed mild cog dysfunction with score of 25. Patient refused csf examination

Remission Characteristics

First week of treatment for he, consciousness and myoclonus improved, prednisolone was tapered in the subsequent two months, in this period there was a regression of signs and symptoms cog impairment and involuntary movement gradually improved witho any treatment other than successive l-thyearsoxine after the 7 months, patient was discharged after 1 week with no obvious symptoms, he has good neurological condition and is witho symptom relapse to date remission occured without corighticoteroid treatment

Treatment & Mechanisms

Proposed Remission Mechanisms

Corticosteroids has been proposed efficacious for he

Clinical Treatment

L-thyearsoxine for chronic thyearsoditis methylprednisolone and prednisone for he

Non-Clinical Treatment

None reported