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Endocrine Abstracts (2007) 14 P334

University Hospital “Virgen Macarena”, Seville, Spain.

In autoimmune thyroid disease some diverse neurological alterations like dementia, psychosis or peripheral neuropathy, are described. Hashimoto’s encephalopathy (EH) is a serious form of these neurological alterations. We describe three cases with different presentation and morphologic normal tests where cerebral SPECT was diagnostic.

Case n°1. A 32-year-old male diagnosed of autoimmune hypothyroidism which presents paresthetics and muscular stiffening, what do not improve with oral levotiroxine. The analyses shows a TSH> 200 and T4L of 0.2 ng/dl, with Ac. antiTPO> 4500 U/ml. After substitution, TSH 9, T4 l 1.80 ng/dl. RMN cranial and EEG were no diagnostic, SPECT shows cortical diffuse hypoperfusión, starting therapy with deflazacort 60 mg/24 h with evident improvement, worsening when the was reduced. Treatment was restored by 2 mg/kg. with resolution of the clinic.

Case n°2. 39-year-old female presents migraine, confusion and agitation with hallucinations and fever treated with aciclovir and antibiotics. A normal thyroid function with Ac. antiTPO >3000 U/ml was found and SPECT show patched cortical affectation in temporal lobe. Therapy with prednisona to 1.5 mg/kg was established, with successful results.

Case n°3. 33-year-old male with hiperthyroidisim autoimmune, in treatment with carbimazole, present a convulsive stroke. Increase TSI (TSI> 40 U/ml) and Ac antiTPO: 5850 U/ml, with normal thyroid function was found (TSH: 0,025 mU/ml, T4L 1,90 ng/dl). A treatment with carbamazepine (800 mg/24 h), discharging him. One month later he shows recidivants convulsive attacks again. Normal RMN, slow wave diffuse EEG without epileptic foci. SPECT showed a decrease of cortical perfusión. Therapy with steroids achieved disapparing the convulsions.

Conclusions: EH’s diagnosis must be considered in subacute presentation, high levels of antithyroid antibodies (even with thyroid normal function) and absence of another pathology. The practice of cerebral SPECT a and a fast response to steroids are important confirmation signs in this pathology.

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