The Clinical Features Of Hashimoto’s Encephalopathy Study

ObjectiveTo investigate the pathogenesis, clinical presentations, laboratory features and prognosis of Hashimoto’s Encephalopathy (HE),in order to improve the diagnosis and treatment of this disease.MethodsWe performed a retrospective analysis on the clinical features, laboratory findings, imaging profiles and treatment outcomes of 28 patients with HE who were admitted to the department of neurology, Qilu Hospital of Shandong University between June 2010 and September 2014.ResultsThe average age of disease onset was 50.11 years(range 20 to 79 years), female: male≈8:1. Common clinical symptoms were ordered as follows:acute and subacute cognitive impairment (9 cases,32.14%), psychiatric symptoms(6 cases,21.42%), seizures (6 cases,21.42%), ataxia (5 cases,17.86%), stroke-like episodes(6 cases, 21.42%), tremor(1 cases,3.57%), hypermyotonia(2 cases,7.14%), disturbance of consciousness (3 cases 10.71%). Abnormality of magnetic resonance imaging was present in 18 cases,14 of them indicate widespread hyper-intesne singals of T1 and T2 in cortical and subcortical area of bilateral frontal, parietal, temporal and occipital lobe or periventricular white matter; 2 patients had hippocampus, temporal lobe abnormal signals; one patient had cerebral atrophy; another one patient had the acute infarction lesion in basal ganglion. Other findings consisted of generalized electroencephalogram abnormality (8 cases), marked increase in serum anti-thyroid peroxidase antibody (anti-TPO) level (24 cases) and elevated anti-thyroglobulin antibody (anti-TG) level (25 cases).23cases were treated with corticosteroid,3 of them with combination of intravenous immune globulin. One patient treated only with general neurotrophic therapy, such as ganglioside. Except for 4 cases showed bad response to steroids, the rest patients had an obvious improvement.ConclusionHE is an encephalopathy with the presence of elevated antithyroid antibodies, most patients showed good response to steroids. So early diagnosis and treatment to improve prognosis is particularly important. This disease should be considered as an important differential diagnosis for encephalopathy of unknown etiology, sreening for serum antithyroid antibody should be performed as initial screening test. At present, the domestic awareness of the disease is not yet fully, only by large sample data statistics and analysis in order to improve the clinicians understanding of the disease and diagnosis and treatment level.