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The diagnostic challenge of Hashimoto’s Encephalopathy

Introduction: The diagnosis of Hashimoto Encephalopathy (HE) is generally considered in patients with a wide range of neurological symptoms, accompanied by normal or nonspecific findings on magnetic resonance imaging and CSF, normal thyroid function or mild hypothyroidism, increased serum levels of thyroid peroxidase antibodies, and clinical response to steroids. Case report: We attended a 76-year-old patient, brought by lowering the level of consciousness 3 days ago, insidiously. Neurological exam: did not obey commands, and only said incomprehensible sounds. Myoclonus in upper limbs and random multidirectional movements of the eyes with horizontal nystagmus, rapid phase to the left. Cranial tomography had only signs of microangiopathy. Electroencephalogram: diffuse slow waves, with no signs of status epilepticus. Laboratory tests: there were increased protein in CSF (107mg/dl) and Anti-TPO serum (>1000 U/ml) levels, without other specific alterations. After these results, therapy with Methylprednisolone 1g/day for 5 days, and Levothyroxine, were chosen. There was a gradual improvement in the neurological condition from the 3rd day of treatment. Conclusion: immediate recognition of Hashimoto encephalopathy is important. Although the pathogenesis is unknown, the disorder is treatable. This entity should always be remembered for the proper direction of therapeutic approaches, thus enabling better outcomes to the patient.