Endocrine Abstracts

Introduction: Hashimoto’s thyroiditis (HT) is one of the frequent endocrine disorder. Clinical picture in Hashimoto’s thyroiditis is predominantly due to associated hypothyroidism and/or goiter related neck complaints. Rarely, HT can be associated with recurrent encephalopathy characterized by seizures, amnesia and comatose episodes. The etiology of this Hashimoto’s encephalopathy (HE) is enigmatically idiopathic and hypothesized to be autoimmune in origin. The treatment is symptomatic and supportive with no curative option. There are meagre anecdotal reports of thyroidectomy role for cure. In this context, we report our experience on impact of total thyroidectomy on HE.

Material & Methods: This is a retrospective study conducted in Endocrine Surgery department of tertiary care Hospital. In all, 5 patients with HT with HE are included in this study. All the clinico-investigative and operative data are scrutinized and analysed. All of them underwent uneventful total thyroidectomy. Informed consent obtained. Mean follow-up after surgery was 2.5±0.9 years (1.7–3.2).

Results: F:M ratio was 4:1 and mean age was 45.6±3.4 (35–55). None had associated hypertension, migraine, diabetes or any other neurological illnesses. All of them had Preoperative serum anti-thyroperoxidase antibody (Anti-TPO Ab) above the upper reference limit of 60 IU/L and was 445±106.2 IU/L (370–650) and post operative level was 61.75±14 IU/L (32–94). In three patients, there were no episodes of HE in follow-up period and in one patient with Anti-TPO Ab of 650, the frequency and severity of HE episodes have decreased from 3 monthly to more than 1 year.

Conclusions: Total thyroidectomy appears to be a viable curative option for Hashimoto’s encephalopathy. Anti-TPO Ab related autoimmunity appears to play a role in HE etiologic cascade. Long term impact and multi-institutional results are required to validate the curative role of surgery for HE.

Keywords: Thyroidectomy, Hashimoto’s thyroiditis, hypocalcemia, thyroid peroxidase antibody, encephalopathy