A case of Hashimoto`s encephalopathy associated with post-thyroidectomy state

Abstract

Hashimoto`s encephalopathy(HE) is a steroid-responsive encephalopathy associated with high titers of antithyroid antibody. Common symptoms of HE are generalized or focal seizure, stroke-like events, temporary neurologic deficits, and variety of psychiatric disturbances. In order to diagnose HE, the most important factor is to detect anti-thytoid antibodies in serum and CSF. We report a patient diagnosed as HE after total thyroidectomy who showed initial symptoms of generalized tonic-clonic seizure, and stuporous mental change. Case : Thirty three year-old man was transferred to neurologic department because of generalized tonic-clonic seizure and stuporous mental change. Nine days before transfer, total thyroidectomy was performed due to papillary cancer. Brain MRI finding was normal. After phenytoin loading, the patient`s mental status improved. But confusion and visual hallucination were persistent. TSH receptor antibody(TSI) was positive in CSF and serum. Anti-microsomal antibody(TPOAB) and antithyroglobulin antibody(TGAB) were positive in serum. EEG showed markedly abnormal finding of generalized depression of the background activity and continuous diffuse irregular theta and delta slowing. Steroid pulse therapy started and patient became alert 2 days later