The clinical features of 17 patients with steroid-responsive encephalopathy associated with autoimmune thyroiditis

Abstract

Objective To investigate the onset pattern, clinical manifestations, laboratory findings and imaging features of 17 Chinese patients with steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT). Methods The clinical data of 17 SREAT patients were collected. Retrospective analysis of their clinical features, as well as their serum levels of anti⁃thyroid, cerebrospinal fluid (CSF) biochemical indicators, MRI and therapy was performed. Results The initial symptoms of those patients were seizures (4 cases), psychiatric symptoms (4 cases), hypomnesis (4 cases), walking unsteadiness (2 cases), headache (2 cases) and dysarthria (1 case). Three cases were acute onset, 5 cases subacute onset and 9 cases chronic onset. The anti-thyroid peroxidase antibody (anti-TPO) of 17 cases were significantly increased, average (928.63 ± 406.28) × 10 3 IU/L. The anti-thyroglobulin antibody (anti-TG) of 15 cases was increased, average (601.27 ± 1014.12) × 10 3 IU/L. The protein in CSF was mildly increased, average (513.75 ± 283.15) mg/L. The EEG of 5 patients presented slow wave and the EEG of 2 patients showed epileptiform discharge. The brain MRI of 11 patients showed multifocal lesions in frontal lobe, temporal lobe, parietal lobe, basal ganglia, centrum ovale, corpus callosum, thalamus, cerebellum, and brain stem. The findings of clinical immunological index and tumor markers were normal. Besides, the prognosis of 11 patients treated with methylprednisolone and 3 patients treated with dexamethasone were good. Recurrence occurred in 2 patients. Conclusion Basically, the clinical features of Chinese SREAT patients present seizures, hypomnesis and psychiatric symptoms associated with increased anti-thyroid and multifocal lesions in gray and white matter of brain.