Endocrine Abstracts

Hashimoto encephalopathy (HE) is a rare and steroid responsive encephalopathy associated with autoimmune thyroiditis (1). Patients with Hashimoto encephalopathy may present with a variety of neuropsychiatric signs (2). 68-year old woman was admitted to the Neurology Department, of Hospital of Lithuanian University of Health Sciences, Kauno klinikos (HLUHS KK), due to disorder of consciousness of uncertain aetiology in August 2016. The signs of motor dysfunction, generalized rigidity, and disorientation, with several episodes of loss of and recurrent episodes of psychosis with hallucinations were observed since 2011. She had hospitalisations in neurology units of several hospitals and was discharged with different diagnoses and modes of treatment. She developed cerebral oedema with abundant myoclonic seizures in extremities in August 2016. The possibility of ischemic, neurodegenerative or neuro-inflammatory disease was ruled out in LUHS KC. Irregular activity of slow range waves was observed in EEG. Brain CT showed no signs of ischemia. High protein concentration was found in lumbar aspirate. Brain MRI SI T2W revealed changes characteristic of HE. Laboratory tests: FT4 6.7 pmol/l (normal 9–21), TSH 17.71 mU/l (0.4–3.6), antiTPO 270 kU/l (0–2), and signs of chronic thyroiditis in thyroid ultrasound made possible to diagnose autoimmune thyroiditis with hypothyroidism and HE. The treatment with L-thyroxine 50 μg/d, and 3-day bolus therapy of Methylprednisolone 1 g/d was started with rapid regression of clinical neurological signs. Prednisolone per os followed, with gradually reduced dose. The patient’s condition improved significantly and she was discharged. During follow-up appointment after 3 months, her neurological state and psychiatric condition were deemed stable, thyroid hormones in normal range on L-thyroxine 50 μg/d. MRI HE changes have regressed. Patients with unexplained encephalopathy, progressive cognitive impairment, polymorphic neuropsychiatric should be considered to rule out HE, MRI and test of antiTPO levels should be performed.