Endocrine Abstracts

JOINT1054

Introduction: Graves’ disease is an autoimmune syndrome primarily characterized by hyperthyroidism, which can also present with goiter, ophthalmopathy, and myxedema. Hyperthyroidism results from thyrotropin receptor antibodies (TRAb) that stimulate thyroid hormone production. While steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is often linked to Hashimoto’s thyroiditis, its occurrence in Graves’ disease is rare. SREAT typically presents with confusion, altered consciousness, and seizures, and may involve autoimmune vasculitis rather than abnormal thyroid hormone levels. We report a rare case of SREAT in a patient with Graves’ disease, presenting with severe neuropsychiatric symptoms.

Methods: A 48-year-old woman presented to the emergency department with disorientation, disinhibition, speech impairment, inability to walk, and visual hallucinations. Her history included depression, anxiety, and recent hyperthyroidism diagnosis.

Results: Extensive diagnostic testing revealed elevated thyroid hormones, suppressed TSH, high anti-TPO antibodies, TRAb, and TSI, leading to a diagnosis of SREAT associated with Graves’ disease. Treatment with high-dose intravenous methylprednisolone, followed by oral corticosteroid tapering, resulted in complete neurological and psychiatric recovery.

Conclusions: This case underscores the importance of recognizing SREAT in patients with Graves’ disease and neuropsychiatric symptoms. Prompt diagnosis and corticosteroid therapy can lead to full recovery, highlighting the need for clinical awareness of this rare condition. Further research is essential to improve diagnostic precision and treatment protocols for SREAT in thyroid autoimmunity.