Endocrine Abstracts

Introduction: Hashimoto’s Encephalopathy (HE) is an autoimmune inflammatory disease of the brain associated with the production of antithyroid antibodies.

Objective: A clinical case of treatment of severe autoimmune encephalopathy in combination with autoimmune thyroiditis and thyrotoxicosis is presented.

Results: A 59-year-old woman was transferred to the intensive care unit diagnosed with thyrotoxic crisis. Objectively: serious condition, inhibited, disoriented to personality, time and place, inadequate, productive contact is difficult, psychomotor agitation. Asymmetry of the nasolabial triangle. Swallowing is not impaired, movements in the limbs within normal. Normothermy. Heart rate 102 per minute, blood pressure 150/95 mmHg. From the anamnesis, about 5 years of thyrotoxicosis, takes thyreostatics, 3 years ago a similar episode of psycho-productive symptoms occurred, the patient was diagnosed with: ‘Pseudodementia Syndrome’; mental status returned to normal without treatment. MRI of the brain: without pathology; in cerebrospinal fluid: protein 3.5 g/l, cytosis 2/3. In the blood and cerebrospinal fluid there is no DNA of herpes simplex virus, cytomegalovirus, Epstein-Barr virus. Procalcitonin and C-reactive protein are normal. Leukocytosis 10.7×10⁹/l, urea 10.3 mmol/l, sodium 150 mmol/l, FT4 26.6, TSH 0.07, antibodies to TPO more than 1000. The conclusion of the council of doctors – autoimmune encephalopathy is possible, course of therapeutic plasmapheresis (No. 3) was prescribed in combination with pulse therapy with methylprednisolone (No. 5 of 1000 mg), followed by oral administration, a gradual dose reduction until complete cancellation. By the 7th day, the patient’s state with pronounced positive dynamics, in consciousness, adequate, oriented to personality, time and place, some emotional lability and partial amnesia. By laboratory methods- transient hyperglycemia and protein-cell dissociation in cerebrospinal fluid. After 3 months, upon reaching the euthyroid state while taking thyreostatics, the patient underwent total thyroidectomy – without complications. Over the next 2 years, episodes of delirium and severe cognitive impairment were not observed.

Conclusion: It is necessary to consider each case of pronounced cognitive impairment with stroke-like symptoms in the prism of Hashimoto’s encephalopathy, which requires timely and special treatment.