Hashimoto’s encephalopathy presenting as acute cognitive decline in an elderly male

Abstract

Hashimoto’s encephalopathy (HE) is a rare form of reversible encephalopathy characterized by the presence of anti-thyroid antibodies in serum and/or cerebrospinal fluid. The syndrome is more common in women and the presentation varies considerably. Here, we report a case of an elderly male with a history of Hashimoto’s thyroiditis, presenting with acute cognitive decline. A diagnosis of HE was established based on the presence of anti-thyroid antibodies in the serum, diffuse electroencephalography changes and lack of an alternative explanation. The patient promptly responded to steroids and was discharged on the 8^th day of admission. We suggest that an assessment of thyroid antibodies should be included in anyone presenting with acute cognitive decline in the absence of alternative explanation.

Keywords: Hashimoto’s encephalopathy; Hashimoto’s thyroiditis; Anti-thyroid antibodies; Electroencephalography; Steroids; Cognitive decline; Immunosuppressants

Core tip: Hashimoto’s encephalopathy is a rare form of reversible encephalopathy characterized by the presence of anti-thyroid antibodies in serum and/or cerebrospinal fluid. We suggest that an assessment of thyroid antibodies should be included in anyone presenting with acute cognitive decline in the absence of alternative explanation.