Journal des troubles thyroïdiens et de la thérapie
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Mixed Clinical Response After Total Thyroidectomy in Two Patients with Hashimoto’s Encephalopathy

Collin Chen, Pratap Chand, Stanley Iyadurai, Mary Scaduto and Mark Varvares

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.