Hashimoto’s Encephalopathy
Description
● Overview:
• Hashimoto thyroiditis is linked to this uncommon autoimmune disease, which primarily affects women (female:male ratio ~4:1).
• Although less often than in adults, it can happen to children and adolescents.
● Clinical manifestations can vary:
• Cognitive impairment; myoclonus; ataxia
• focal or generalised epilepsy
• status epilepticus
• stroke-like episodes
• psychiatric symptoms, such as mood swings, melancholy, or irritability
● Although the pathogenesis is unknown, potential pathways include:
• Autoimmune response (attack by antithyroid antibodies on the central nervous system).
• Microvascular inflammation, also known as vasculitis.
• Hormone toxic/deregulatory effects (e.g., TRH).
● The diagnosis:
Exclusionary clinical diagnosis: exclude metabolic, neoplastic, autoimmune, infectious, and toxic causes.
➣ The following are essential diagnostic criteria:
• Encephalopathy with seizures, myoclonus, hallucinations, or episodes resembling a stroke.
• Thyroid illness (typically moderate hypothyroidism or subclinical thyroid disease) is present.
• Normal or nonspecific abnormalities on brain MRI.
• TPO-Ab and TG-Ab, or serum antithyroid antibodies.
• Serum or CSF does not include any additional neuronal antibodies.
• Neglecting other potential reasons.
➣ Examinations:
• MRI: may reveal white matter abnormalities that are not specific.
• EEG: nonspecific diffuse slow-wave activity.
• CSF: often high protein, sporadic leukocytosis, and possible presence of antithyroid antibodies.
• Thyroid function can be either overtly hypothyroid, subclinical hypothyroid, or normal.
● Case Report: A girl of 12 years old
➣ Signs include headache, nausea, tremors, dysarthria, mood swings, lower limb weakness, and spatiotemporal disorientation.
➣ Neurological tests: positive Romberg, dysphonia.
Hyperintense white matter patches on MRI.
• EEG: diffuse slow waves on both sides.
• CSF: positive TPO-Ab & TG-Ab; little protein increase.
• The thyroid is largely functioning normally.
Protocol
● Medical Management:
➣ Drugs: Antiarrhythmics are used to regulate arrhythmias, and diuretics are used to treat the symptoms of heart failure. To avoid thromboembolic events, particularly in individuals with atrial arrhythmias, anticoagulation therapy is recommended.
➣ Monitoring: Echocardiograms and electrocardiograms are performed on a regular basis to evaluate heart function and identify any issues.
● Surgical Management:
➣ Valve Repair or Replacement: To address the tricuspid valve abnormality, surgery may be required. Arrhythmia Surgery: To treat potentially fatal arrhythmias, procedures such as catheter ablation may be carried out.
➣ Palliative Surgery: Techniques such as the Starnes technique can save the lives of newborns with severe symptoms.
● Patient care and nursing interventions:
➣ Issue: Inefficient tissue perfusion
Intervention: Keep an eye on oxygen saturation levels and vital signs.
➣ Management: When necessary, give oxygen treatment and prescription drugs.
➣ Result: Increased tissue perfusion and oxygenation.
➣ Issue: Potential Infection
➣ Intervention: Adhere to stringent aseptic protocols and care.
➣ Management: Inform the patient and their family about ways to prevent infections.
➣ Result: A decrease in the frequency of surgical site infections.
➣ Issue: Fear
➣ Management: Promote relaxing methods and include family in care.
➣ Intervention: Offer emotional support and information about the problem and treatment plan.
➣ Result: Better coping and lower anxiety levels.
➣ Issue: Lack of Knowledge
➣ Intervention: Inform the patient and their loved ones about the illness, available treatments, and lifestyle changes.
➣ Management: Make written documents and informational resources available.
➣ Result: Improved comprehension and compliance with the treatment strategy.
Notes
For more information visit
10.23750/abm.v91i3.10157
