Mixed Clinical Response After Total Thyroidectomy in Two Patients with Hashimoto’s Encephalopathy
|Collin Chen1, Pratap Chand3, Stanley Iyadurai3, Mary Scaduto2 and Mark Varvares2*|
|1Saint Louis University School of Medicine degree program, USA|
|2Department of Otolaryngology, Head and Neck Surgery, Saint Louis University School of Medicine, USA|
|3Department of Neurology and Psychiatry, Saint Louis University School of Medicine, USA|
|Corresponding Author :||Mark Varvares
Address: 3635 Vista Avenue at Grand Blvd
St Louis, MO, 63110, USA
E-mail: [email protected]
|Received July 13, 2013; Accepted September 18, 2013; Published September 20, 2013|
|Citation: Chen C, Chand P, Iyadurai S, Scaduto M, Varvares M (2013) Mixed Clinical Response After Total Thyroidectomy in Two Patients with Hashimoto’s Encephalopathy. Thyroid Disorders Ther 2:131. doi:10.4172/2167-7948.1000131|
|Copyright: © 2013 Chen C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Importance: Hashimoto’s encephalopathy (HE) is currently treated with medical therapy. Only one case of thyroidectomy as treatment for HE has been presented in the literature. We present two patients with distinct manifestations of (HE) who underwent thyroidectomy after minimal response to medical management.
Observations: Patient 1 is a 71 year-old female who presented with motor restlessness. She had persistently elevated antithyroid antibodies. After thyroidectomy, her symptoms were only mildly improved. Iodine-123 thyroid scan revealed a small remnant of thyroid tissue. Her antithyroid antibodies remained elevated. Patient 2 is a 60 year-old female with previous diagnosis of (HE) who presented with recurrent seizures. She had a history of elevated antithyroid antibodies. After thyroidectomy, she no longer had seizures, and her antithyroid antibodies normalized.
Conclusions and relevance: Patient 1 did not improve as quickly as patient 2. A possible explanation for this is the thyroid tissue remnant found in the first patient during a follow-up iodine-123 thyroid scan; the remnant could be responsible for persistently elevated antithyroid antibodies. The degree or pattern of preoperative antithyroid antibody elevation does not seem to be predictive of postoperative response. Thyroidectomy is a reasonable treatment option for the severely symptomatic patient who has failed medical therapy with steroids, IVIG, and plasmapharesis.