Riangwiwat Tanawan, Sangtian Jutarat, Sriphrapradang Chutintorn
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University,Thailand.
BMJ Case Rep. 2015 Mar 12;2015:bcr2014208969. doi: 10.1136/bcr-2014-208969.
We present a case of a patient who was diagnosed with Hashimoto's encephalopathy based on the presence of subacute behavioural changes, negative work up for infection and immunological serology except for high serum titres of thyroid autoantibodies. Thyroid function tests (TFTs) and MRI of the brain were normal. EEG showed low amplitude, slow waves and θ waves at both frontal areas. His condition improved dramatically after treated with high-dose glucocorticoid. After 2 years of a relapsing-remitting course, a new episode occurred. There was an abrupt change of TFTs within 5 days: free thyroxine (fT4) from 1.52 to 1.53 ng/mL, free triiodothyronine (fT3) from 3.25 to >30 pg/mL and thyroid-stimulating hormone (TSH) from 5.08 to 0.78 mIU/L. On the following day found fT4 2.58, fT3 14.67 and TSH 0.042. The patient was diagnosed with Hashitoxicosis. High-dose glucocorticoid and β-blockers were initiated. The symptoms gradually improved and TFTs normalised within 2 weeks.
我们报告一例患者，该患者基于亚急性行为改变、感染及免疫血清学检查阴性（除甲状腺自身抗体血清滴度高外）被诊断为桥本脑病。甲状腺功能检查（TFTs）及脑部MRI均正常。脑电图显示双侧额叶低波幅、慢波及θ波。经大剂量糖皮质激素治疗后其病情显著改善。在经历2年的复发-缓解病程后，出现了一次新的发作。5天内甲状腺功能检查结果突然变化：游离甲状腺素（fT4）从1.52升至1.53 ng/mL，游离三碘甲状腺原氨酸（fT3）从3.25升至>30 pg/mL，促甲状腺激素（TSH）从5.08降至0.78 mIU/L。次日，fT4为2.58，fT3为14.67，TSH为0.042。该患者被诊断为桥本甲状腺毒症。开始使用大剂量糖皮质激素及β受体阻滞剂治疗。症状逐渐改善，甲状腺功能检查在2周内恢复正常。
