Hidig Mohamed Farah Osman, Bashir Ahmed Muhammad, Hassan Mohamed Sheikh, Adam Bakar Ali, Jeele Mohamed Osman Omar
Department of Neurology, Mogadishu Somali Turkey Training and Research Hospital.
Department of Internal Medicine, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia.
Ann Med Surg (Lond). 2025 Jan 9;87(1):347-350. doi: 10.1097/MS9.0000000000002787. eCollection 2025 Jan.
Hashimoto's thyroiditis (HT) is a common autoimmune condition that causes hypothyroidism. It is characterized by a wide range of symptoms, from conventional ones to rare and severe neurological manifestations. Seizures are a very uncommon symptom of HT, requiring a deep understanding and careful management owing to the challenges involved in diagnosing and the severe implications.
A 19-year-old female with a medical history of untreated hypothyroidism caused by HT presented with a seizure characterized by generalized tonic-clonic movements. She displayed symptoms of fatigue, confusion, and swelling in the extremities. The laboratory results indicated a significant case of autoimmune hypothyroidism. The results of the brain imaging and EEG tests were within the expected range and did not show any abnormalities. The treatment regimen consisted of levothyroxine, levetiracetam, and methyl-prednisolone, which led to the cessation of seizures and the patient's recovery from the postictal state.
While managing HT itself is well-defined, tackling the neurologic complexities of Hashimoto's encephalopathy (HE) takes a multifaceted approach.
This case highlights the intricate nature of diagnosing and managing neurological symptoms caused by HT, namely seizures. Patients presenting with unexplained seizures and autoimmune thyroid illness should be mindful of the possibility of HE, an uncommon condition. Management includes the attainment of normal thyroid function and the consideration of immunosuppressive therapy for severe instances of HE.
桥本甲状腺炎(HT)是一种常见的自身免疫性疾病,可导致甲状腺功能减退。其症状范围广泛,从常见症状到罕见且严重的神经表现。癫痫发作是HT非常罕见的症状,由于诊断存在挑战且后果严重,需要深入理解并谨慎处理。
一名19岁女性,有HT所致未经治疗的甲状腺功能减退病史,出现以全身强直阵挛运动为特征的癫痫发作。她表现出疲劳、意识模糊和四肢肿胀的症状。实验室结果显示为严重的自身免疫性甲状腺功能减退病例。脑部影像学和脑电图检查结果在预期范围内,未显示任何异常。治疗方案包括左甲状腺素、左乙拉西坦和甲泼尼龙,这导致癫痫发作停止,患者从发作后状态恢复。
虽然HT本身的管理已明确,但应对桥本脑病(HE)的神经复杂性需要多方面的方法。
本病例突出了诊断和管理由HT引起的神经症状(即癫痫发作)的复杂性。出现不明原因癫痫发作和自身免疫性甲状腺疾病的患者应注意HE这种罕见情况的可能性。管理包括使甲状腺功能恢复正常,以及对严重的HE病例考虑免疫抑制治疗。