Figgie Mark P, Kelly Hannah, Pyatka Natalie, Chu Clara, Abboud Hesham
Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
J Neurol Sci. 2024 Mar 15;458:122908. doi: 10.1016/j.jns.2024.122908. Epub 2024 Jan 30.
Hashimoto's Encephalopathy (HE) manifests with various neurologic symptoms associated with elevated thyroglobulin (TG) and/or thyroperoxidase (TPO) antibodies. Some patients with thyroid antibodies exhibit neurological presentations not consistent with HE. This study aims to characterize the spectrum of neurological morbidity in patients with thyroid antibodies.
We reviewed all patients tested for TG or TPO antibodies from 2010 to 2019. Patients tested for thyroid antibodies as part of a neurological workup for new symptoms were classified into the following categories: patients meeting full criteria for HE, patients with other neuroimmunological disorders, patients with unexplained neurological symptoms not fully meeting HE criteria, and patients with incidental non neuroimmunological disorders.
There were 2717 patients with positive thyroid antibodies in the dataset including 227 patients (78% female, age 54 ± 19 years) who met inclusion criteria. Twelve patients (5%) met HE criteria, 30 (13%) had other neuroimmunological disorders, 32 (14%) had unexplained neurological symptoms, and 153 (67.4%) had incidental disorders. In addition to cognitive dysfunction, seizures, movement disorders, motor weakness, and psychosis, HE patients were also more likely to have cerebellar dysfunction, language impairment, and sensory deficits. They were more likely to carry a Hashimoto's thyroiditis diagnosis and had higher titers of thyroid antibodies. They all had a robust response to steroids.
The neurological spectrum of HE may be wider than previously reported, including frequent cerebellar, sensory, and language dysfunction. A subgroup of thyroid antibody positive patients with unexplained neurological symptoms may represent further expansion of thyroid antibody-related neurological disorders.
桥本脑病（HE）表现为与甲状腺球蛋白（TG）和/或甲状腺过氧化物酶（TPO）抗体升高相关的各种神经症状。一些甲状腺抗体阳性的患者表现出与HE不一致的神经症状。本研究旨在描述甲状腺抗体阳性患者的神经疾病谱。
我们回顾了2010年至2019年所有检测TG或TPO抗体的患者。因新出现的症状而进行甲状腺抗体检测作为神经科检查一部分的患者被分为以下几类：符合HE全部标准的患者、患有其他神经免疫性疾病的患者、有无法解释的神经症状但未完全符合HE标准的患者、以及患有偶发性非神经免疫性疾病的患者。
数据集中有2717例甲状腺抗体阳性患者，其中227例（78%为女性，年龄54±19岁）符合纳入标准。12例（5%）符合HE标准，30例（13%）患有其他神经免疫性疾病，32例（14%）有无法解释的神经症状，153例（67.4%）患有偶发性疾病。除了认知功能障碍、癫痫发作、运动障碍、肌无力和精神病外，HE患者还更有可能出现小脑功能障碍、语言障碍和感觉缺陷。他们更有可能被诊断为桥本甲状腺炎，并且甲状腺抗体滴度更高。他们对类固醇均有显著反应。
HE的神经疾病谱可能比先前报道的更广泛，包括频繁出现的小脑、感觉和语言功能障碍。一部分甲状腺抗体阳性且有无法解释的神经症状的患者可能代表了甲状腺抗体相关神经疾病的进一步扩展。
