Clinical analysis of 22 cases with Hashimoto's encephalopathy

Abstract

Objective To investigate the clinical presentations of Hashimoto's encephalopathy (HE), so as to improve the diagnosis and treatment of this disease. Methods A retrospective analysis was performed on clinical features, laboratory findings, imaging profiles, treatment and outcomes of 22 patients with HE who were admitted to our hospital between June 2010 and September 2013.  Results Clinical symptoms were mainly acute or subacute cognitive impairment (9 cases), psychiatric symptoms (6 cases), seizures (5 cases), ataxia (5 cases), stroke-like episodes (6 cases), tremor (1 case), myoclonus (2 cases) and disturbance of consciousness (3 cases). Marked increase was found in serum anti-thyroid peroxidase (anti-TPO) antibody level (19 cases) and anti-thyroglobulin (anti-TG) antibody level (20 cases). Twenty-one cases were treated with glucocorticoids, and one patient was treated only with general neurotrophic therapy, such as ganglioside. Except for 4 cases showed bad response to steroids, the rest patients had an obvious improvement. Conclusions Hashimoto's encephalopathy is an encephalopathy with the presence of elevated antithyroid antibodies, and most patients showed good response to steroids. So early diagnosis and treatment is particularly important for improving prognosis. This disease should be considered as an important differential diagnosis for encephalopathy of unknown etiology, and screening for serum antithyroid antibodies should be performed as initial screening test.

doi: 10.3969/j.issn.1672-6731.2014.07.008