Hashimoto encephalopathy

What is it about?

Hashimoto's thyroiditis is the most common form of thyroiditis. Since first description in 1966, this disorder was associated with encephalopathy, which is unrelated to thyroid's function status. Hashimoto encephalopathy is presented with neurologic or neuropsychiatric symptoms in euthyroid or mildly hypothyroid patients. Although elevated concentrations of antithyroid antibodies are requested for the diagnosis, no correlation between the severity of the syndrome and the antibody levels has been found. Typically, two types of encephalopathy are described: a stroke-like type, with transient symptoms and focal neurological signs, with or without mental changes and a diffuse, progressive type with cognitive impairment, seizures and psychotic symptoms. Although most of reported cases of this rare syndrome are presented with the specific manifestations of each subtype, these two subtypes may rarely overlap, particularly in the long-term course. The objective of this report was to describe a case of encephalopathy associated with thyroiditis Hashimoto, initially manifested with clinical symptoms of both subtypes.

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Why is it important?

A female 55-year-old patient with history of Hashimoto thyroiditis, hypertension and hyperlipidemia, revealed transient episodes of few minutes duration each, with dystonic phenomena from facial and upper limbs muscles. In the same period, the patient developed a progressive speech and gait apraxia, mental and movement retardation and also a global cognitive impairment. The patient underwent clinical, laboratory, radiological and neuropsychological examination. Although Hashimoto encephalopathy is a rare clinical syndrome, it should be considered in the differential diagnosis of cases of Hashimoto's thyroiditis that develop neurological or neuropsychiatric symptoms, even if the thyroid function is normal.

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