Abstract
Hashimoto’s thyroiditis is a common endocrine disorder. Clinical presentation in Hashimoto’s thyroiditis is predominantly due to associated hypothyroidism with or without goiter-related neck complaints. Rarely, HT can be associated with recurrent encephalopathy characterized by seizures, amnesia, and comatose episodes. The treatment for this enigmatic disease is symptomatic and supportive with no curative option. There are meager, anecdotal reports on the role of thyroidectomy as a treatment option. In this context, we report our experience on impact of total thyroidectomy on Hashimoto’s encephalopathy, refractory to anti-epileptic medications and steroids. This is a retrospective study conducted in an endocrine surgery department of a tertiary care hospital. Three patients with Hashimoto’s encephalopathy are included in this study. All the clinico-investigative and operative data are scrutinized and analyzed. All of them underwent uneventful total thyroidectomy. Written informed consent was obtained in all cases. Mean follow-up after surgery was 1.6 SD 0.8 years (1.2–2.8). Mean age was 46 ± 6.4 years (39–52). None of the patients had associated hypertension, migraine, diabetes, or any other neurological illnesses. The mean preoperative serum anti-thyroperoxidase antibody level was 445 SD 106.2 IU/L (370–700), which was above the upper reference limit of 60 IU/L and post-operative level was 62.75 SD 34 IU/L (32–104). There was complete remission of seizure attacks in all the cases till the last follow-up period. Total thyroidectomy appears to be a viable curative option for refractory Hashimoto’s encephalopathy. Anti-thyroperoxidase antibody-related autoimmunity appears to play a role in Hashimoto’s encephalopathy etiologic cascade. Long-term impact and multi-institutional results are required to validate the curative role of surgery in this condition.
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References
World Medical Organization (2004) Declaration of Helsinki. BM J 313:1448–1449
Tunbridge WM, Vanderpump MP (2000) Population screening for autoimmune thyroid disease. Endocrinol Metab Clin N Am 29:239–253
Hegedus L, Hansen JM, Feldt-Rasmussen U (1991) Influence of thyroxine treatment on thyroid size and antithyroid peroxidase antibodies in Hashimoto’s thyroiditis. Clin Endocrinol 35:235–238
Bhargav PR, Shekhar S (2011) Surgical indications for goiter with background Hashimoto’s thyroiditis: institutional experience. Indian J Surg 73:414–418
Shih ML, Lee JA, Hsieh CB, Yu JC, Liu HD, Kebebew E, Clark OH, Duh QY (2008) Thyroidectomy for Hashimoto’s thyroiditis: complications and associated cancers. Thyroid 18:729–734
Kochupillai N (2000) Clinical endocrinology in India. Curr Sci 79:1061–1067
Ferracci F, Moretto G, Candeago RM, Cimini N, Conte F, Gentile M, Papa N, Carnevale A (2003) Antithyroid antibodies in the CSF: their role in the pathogenesis of Hashimoto’s encephalopathy. Neurology 60:712–714
Ferracci F, Carnevale A (2006) The neurological disorder associated with thyroid autoimmunity. J Neurol 253:975–984
Henchey R, Cibula J, Helveston W, Malone J, Gilmore R (1995) Electro-encephalographic findings in Hashimoto’s encephalopathy. Neurology 45:977–981
Watemberg N, Greenstein D, Levine A (2006) Encephalopathy associated with Hashimoto thyroiditis: pediatric perspective. J Child Neurol 21:1–5
Barker R, Zajicek J, Wilkinson I (1996) Thyrotoxic Hashimoto’s encephalopathy. J Neurol Neurosurg Psychiatry 60:234
Asher R (1949) Myxoedematous madness. Br Med J 2:555–562
Cantón A, de Fàbregas O, Tintoré M, Mesa J, Codina A, Simó R (2000) Encephalopathy associated to autoimmune thyroid disease: a more appropriate term for an underestimated condition? J Neurol Sci 176:65–66
Rodriguez AJ, Jicha GA, Steeves TD, Benarroch EE, Westmoreland BF (2006) EEG changes in a patient with steroid-responsive encephalopathy associated with antibodies to thyroperoxidase (SREAT, Hashimoto’s encephalopathy). J Clin Neurophysiol 23:371–373
Peschen-Rosin R, Schabet M, Dichgans J (1999) Manifestation of Hashimoto’s encephalopathy years before onset of thyroid disease. Eur Neurol 41:79–84
Katoh N, Yoshida T, Shimojima Y, Gono T, Matsuda M, Yoneda M, Ikeda SI (2007) An 85-year-old case with Hashimoto’s encephalopathy, showing spontaneous complete remission. Intern Med 46:1613–1616
Gini B, Lovato L, Cianti R, Cecotti L, Marconi S, Anghileri E, Armini A, Moretto G, Bini L, Ferracci F, Bonetti B (2008) Novel autoantigens recognized by CSF IgG from Hashimoto’s encephalitis revealed by a proteomic approach. J Neuroimmunol 196:153–158
Zettinig G, Asenbaum S, Fueger BJ, Hofmann A, Diemling M, Mittlboeck M, Dudczak R (2003) Increased prevalence of sublinical brain perfusion abnormalities in patients with autoimmune thyroiditis: evidence of Hashimoto’s encephalitis? Clin Endocrinol 59:637–643
Chen N, Qin W, Wei C, Wang X, Li K (2011) Time course of Hashimoto’s encephalopathy revealed by MRI: report of two cases. J Neurol Sci 300:169–172
Allam H, Kassar D, Chand P, Iyadurai S (2013) Treatment of refractory Hashimoto’s encephalitis by thyroidectomy. Neurology 80(7S)
Yuceyar N, Karadeniz M, Erdogan M, Copur A, Akgun A, Kumral E, Ozgen G (2007) Thyrotoxic autoimmune encephalopathy in a female patient: only partial response to typical immunosuppressant treatment and remission after thyroidectomy. Clin Neurol Neurosurg 109:458–462
Chen C, Chand P, Iyadurai S, Scaduto M, Vavares M (2013) Mixed clinical response after total thyroidectomy in two patients with Hashimoto’s encephalopathy. Thyroid Disorders Ther 2:131. https://doi.org/10.4172/2167-7948.1000131
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Panchangam, R.B., Kota, S.K. & Mayilvaganan, S. Clinical Response to Thyroidectomy in Three Cases of Refractory Hashimoto’s Encephalopathy—a Potential Therapy. Indian J Surg 83, 708–711 (2021). https://doi.org/10.1007/s12262-020-02476-5
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DOI: https://doi.org/10.1007/s12262-020-02476-5