Encephalopathy associated with dysthyroidism with positive anti-peroxidase antibodies

Abstract

Introduction: Hashimoto’s encephalopathy is a condition associated with dysthyroidism and other autoimmune diseases. The pathophysiology is unclear and clinically the disease is characterized by neurological and psychiatric alterations in absence of brain infection. Antithyroid antibodies are high and imaging studies may be normal. Corticosteroid therapy is the treatment of choice. Case report: A 36-year-old woman with monoparesis, behavior and personality changes and hyperthyroidism. Lumbar puncture was done and infectious, metabolic and neoplastic encephalopathy causes were ruled out. MRI skull was requested, it reports compatible images with various brain abscesses of undetermined origin. Considering a probable Hashimoto encephalopathy, anti-peroxidase and thyroglobulin antibodies were requested, detecting high titers. Corticosteroids and immunoglobulin scheme were started with a poor response to the treatment. Conclusions:This case associated Hashimoto’s encephalopathy with hyperthyroidism, a rare association reported in the literature. It was suspected a CNS primary vasculitis due to high values of complement, however, brain biopsy was not performed to define a more accurate diagnosis.