Jihad Youssef, Bassem Awada and Najiha Dhaybi
Hashimoto’s encephalopathy is considered as an autoimmune encephalopathy characterized by sub-acute altered level of consciousness associated with high titers of anti-thyroid peroxidase antibodies. In steroid resistant cases, intravenous immunoglobulin, plasmapheresis and other immunotherapy may be an effective treatment. Herein, we describe a case report of 62 years old lady presented for acute onset of altered level of consciousness. All labs, lumbar puncture and imaging including MRI of brain were not significant. Thyroid function tests were normal, but anti-TPO was more than 1000. Excluding all other common causes of altered level of consciousness, elevated level of Anti-TPO lead us to think of Hashimoto encephalopathy. We treated the patient with steroid bolus therapy for 3 days and completing with dose of 1 mg/kg for a total of seven days, with no improvement. Then, we decided to do several sessions of plasmapheresis after which the patient started gaining her consciousness. This case further supports plasma exchange as a potentially beneficial treatment modality, in severe cases of Hashimoto’s encephalopathy which are completely or partially resistant to steroids.
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