VCOM Louisiana Research Day Program

Clinical & Case Studies

Allison Tran, OMS-III; Vivek Moorthy, MD; Laura Kimball-Ravari, MD Edward Via College of Osteopathic Medicine-Louisiana; Willis Knighton Health System 34 AN ATYPICAL PRESENTATION OF HASHIMOTO’S ENCEPHALOPATHY: A CASE REPORT

Hashimoto’s Encephalopathy (HE) is loosely characterized by the presence of elevated anti thyroid antibodies, neuropsychiatric symptoms, and response to steroids. The pathophysiology, although not well understood, is widely thought to be autoimmune in nature. Clinical presentation can vary but systemic symptoms are rare. The presence of autoantibodies in blood, elevated protein and lymphocytic pleocytosis in cerebral spinal fluid (CSF), and non-specific electroencephalogram (EEG) changes are common among patients, but it is a diagnosis of exclusion in current practice. The mainstay of treatment involves glucocorticoids and thyroid hormone replacement with a mostly favorable prognosis. We present the case of a 40-year-old Caucasian male with multinodular goiter and Hashimoto’s thyroiditis who was evaluated for depression, paranoia, and altered mentation following episodes of spontaneous, severe urticaria. Following fine needle aspiration (FNA) biopsy and molecular marker evaluation, the thyroid nodules were reported benign. His anti-thyroglobulin (Tg-Ab) antibody titer was extremely elevated at >4000 IU/mL while his anti-thyroid peroxidase antibodies (TPO-Ab) were only mildly elevated at 76 IU/mL. Although the majority of HE patients demonstrate elevated

TPO-Ab, there is minimal literature noting a markedly elevated Tg-Ab as seen in this patient. 1 Thyroid stimulating hormone (TSH) was within normal limits on treatment with levothyroxine. Corticosteroid treatment was initiated. This case serves as an addition to the literature in terms of clinical presentation and laboratory findings to aid syndrome detection.

47 2023 Via Research Recognition Day