Karan Abhinav, Nuthulaganti Swetha R, Zhang Yixin, Kandah Fadi, Gutierrez Maria, Reddy Pramod
Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.
Medicine, University of Florida Health Jacksonville, Jacksonville, USA.
Cureus. 2022 Jul 14;14(7):e26853. doi: 10.7759/cureus.26853. eCollection 2022 Jul.
Hashimoto's encephalopathy is a nebulous entity over which much controversy exists. Often referred to as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), it describes a myriad of neurological sequelae that typically are observed to occur in patients with the presence of thyroid antibodies. We aim to raise clinical awareness of this seldom diagnosed entity as a potential etiology for altered mental status in patients who present with supporting clinical features and elevated thyroid antibodies. While steroid responsiveness is deemed a typical presenting feature of this medical condition, our cases aim to describe two cases that required escalation of therapy to intravenous immunoglobulins, and ultimately, plasmapheresis therapy for improvement in their clinical status. Our patients had a dramatic improvement in their mentation within three to four sessions of plasmapheresis, improving rapidly toward their baseline. Such a dramatic improvement, coupled with the corresponding reduction in their thyroid antibody titer supports the diagnosis of Hashimoto's encephalopathy and highlights the importance of having a low clinical threshold for the diagnosis of this entity in patients who, despite extensive evaluation, reveal no apparent cause for their altered mental status.
桥本脑病是一个存在诸多争议的模糊概念。它常被称为与自身免疫性甲状腺炎相关的类固醇反应性脑病（SREAT），描述了一系列通常在存在甲状腺抗体的患者中观察到的神经后遗症。我们旨在提高对这种罕见诊断疾病的临床认识，它可能是出现支持性临床特征和甲状腺抗体升高的患者精神状态改变的潜在病因。虽然类固醇反应性被认为是这种病症的典型表现特征，但我们的病例旨在描述两例需要将治疗升级为静脉注射免疫球蛋白，最终采用血浆置换疗法以改善临床状况的病例。我们的患者在进行三到四次血浆置换后，精神状态有了显著改善，迅速恢复到基线水平。如此显著的改善，再加上甲状腺抗体滴度相应降低，支持了桥本脑病的诊断，并凸显了对于那些尽管经过广泛评估但仍未发现精神状态改变明显原因的患者，在诊断该疾病时保持较低临床阈值的重要性。
