DeBiase Joseph M, Avasthi Deepti
Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA.
Cureus. 2020 Aug 7;12(8):e9601. doi: 10.7759/cureus.9601.
We present the case of a male patient, initially treated for myxedema coma secondary to Hashimoto's thyroiditis, who was discharged on levothyroxine and a low-dose steroid taper but was re-admitted for the treatment of status epilepticus. During the second admission, the patient developed encephalopathy and cognitive dysfunction. Thyroid peroxidase (TPO) antibodies (Abs) were elevated and the patient was treated with high-dose steroids with clinical improvement. The patient was determined to have Hashimoto's encephalopathy (HE) due to the clinical picture as well as the response to high-dose glucocorticoid therapy. Cerebrospinal fluid (CSF) analysis demonstrated elevated protein, immunoglobulin G (IgG) index, and IgG synthesis rate; however, albumin index was elevated, indicating a disrupted blood-brain barrier. We suggest that HE be considered in the differential diagnosis for patients presenting with seizures, coma, stroke-like symptoms, behavior changes, and unexplained encephalopathy. After ruling out more common pathologies, HE should be considered by testing for anti-TPO Abs.
我们报告一例男性患者，最初因桥本甲状腺炎继发黏液性水肿昏迷接受治疗，出院时服用左甲状腺素和低剂量逐渐减量的类固醇，但因癫痫持续状态再次入院治疗。在第二次住院期间，患者出现脑病和认知功能障碍。甲状腺过氧化物酶（TPO）抗体升高，患者接受高剂量类固醇治疗后临床症状改善。根据临床表现以及对高剂量糖皮质激素治疗的反应，该患者被诊断为桥本脑病（HE）。脑脊液（CSF）分析显示蛋白、免疫球蛋白G（IgG）指数和IgG合成率升高；然而，白蛋白指数升高，表明血脑屏障遭到破坏。我们建议，对于出现癫痫发作、昏迷、类中风症状、行为改变和不明原因脑病的患者，在鉴别诊断时应考虑HE。排除更常见的病因后，应通过检测抗TPO抗体来考虑诊断HE。
