J Clin Neurol.  2008 Dec;4(4):167-170. 10.3988/jcn.2008.4.4.167.

Steroid-Responsive Recurrent Encephalopathy Associated with Subacute Thyroiditis

• Chung YJ
• Park KY
• Ahn J
• Ha SY
• Youn YC

• KMID: 2287671
• DOI: http://doi.org/10.3988/jcn.2008.4.4.167

Abstract

BACKGROUND
Steroid-responsive encephalopathy associated with subacute thyroiditis has, to our knowledge, not been reported previously. CASE REPORT: A 49-year-old woman was found collapsed and brought to our institution with decreased mentality, dysarthria, and gait disturbance. Brain magnetic resonance imaging and angiography were normal but blood tests revealed thyroid-autoantibody-negative thyrotoxicosis. Results of a (99m)technetium-pertechnetate scan were compatible with the thyrotoxic phase of subacute thyroiditis. 14-3-3 proteins were detected in cerebrospinal fluid. Her mental status began to improve from the day following steroid administration. Recurrent encephalopathy was found 2 months after the initial admission, which was also effectively treated with steroid. CONCLUSIONS:We speculate that steroid-responsive recurrent encephalopathy associated with subacute thyroiditis is a subtype of Hashimoto's encephalopathy, and consider that steroid treatment should not be delayed in suspected patients.

Keyword

brain diseases; 14-3-3 proteins; subacute thyroiditis

MeSH Terms

14-3-3 Proteins
Angiography
Brain
Brain Diseases
Dysarthria
Female
Gait
Hashimoto Disease
Hematologic Tests
Humans
Magnetic Resonance Imaging
Middle Aged
Thyroiditis, Subacute
Thyrotoxicosis
14-3-3 Proteins
Brain Diseases
Hashimoto Disease

Figure

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  Fig. 1 99mTechnetium-pertechnetate scan showing poor visualization of the thyroid.

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  Fig. 2 Fine-needle-aspiration cytology of the thyroid revealing multinucleated giant cells in the background of inflammatory cells. The black arrow indicates a multinucleated giant cell (Papanicolaou staining; ×400 magnification).

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