Wolfgang J Schnedl1, Siroos Mirzaei2, Sandra J Wallner-Liebmann3, Erwin Tafeit4, Harald Mangge5, Robert Krause6, Rainer W Lipp7. 1. Practice for General Internal Medicine, Bruck/Mur, Medical University of Graz, Austria. 2. Department of Nuclear Medicine, Wilhelminenspital, Vienna, Medical University of Graz, Austria. 3. Institute of Pathophysiology, Centre for Molecular Medicine, Medical University of Graz, Austria. 4. Institute of Physiological Chemistry, Centre of Physiological Medicine, Medical University of Graz, Austria. 5. Clinical Institute of Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Austria. 6. Department of Internal Medicine, Medical University of Graz, Graz, Austria. 7. Department of Radiology, Medical University of Graz, Graz, Austria.
Abstract
BACKGROUND: Hashimoto's encephalopathy (HE) is a rare immune-mediated encephalopathy associated with autoimmune Hashimoto's thyroiditis. OBJECTIVES AND METHODS: We report on a patient with HE and significant clinical improvement correlating with an increase in cerebral blood flow demonstrated by hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography (SPECT). HMPAO-SPECT was performed with 740 MBq of technetium-99m-HMPAO. To demonstrate the improvement in regional cerebral blood flow, individual regions of interest were drawn around visually diminished HMPAO uptake, the lesion to reference region ratio was calculated and transverse section images and semi-quantitative measurements were performed. RESULTS: We show a 5-year follow-up with significant clinical improvement, a 10-fold reduction in autoantibodies to thyroid peroxidase and an approximately 20% improvement in cerebral blood flow with HMPAO-SPECT. CONCLUSION: Adequate levothyroxine treatment achieving and maintaining euthyroidism should be considered as therapy to lower autoantibodies and improve clinical outcome in patients with Hashimoto's thyroiditis and encephalopathy.
BACKGROUND: Hashimoto's encephalopathy (HE) is a rare immune-mediated encephalopathy associated with autoimmune Hashimoto's thyroiditis. OBJECTIVES AND METHODS: We report on a patient with HE and significant clinical improvement correlating with an increase in cerebral blood flow demonstrated by hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography (SPECT). HMPAO-SPECT was performed with 740 MBq of technetium-99m-HMPAO. To demonstrate the improvement in regional cerebral blood flow, individual regions of interest were drawn around visually diminished HMPAO uptake, the lesion to reference region ratio was calculated and transverse section images and semi-quantitative measurements were performed. RESULTS: We show a 5-year follow-up with significant clinical improvement, a 10-fold reduction in autoantibodies to thyroid peroxidase and an approximately 20% improvement in cerebral blood flow with HMPAO-SPECT. CONCLUSION: Adequate levothyroxine treatment achieving and maintaining euthyroidism should be considered as therapy to lower autoantibodies and improve clinical outcome in patients with Hashimoto's thyroiditis and encephalopathy.
Authors: Georg Zettinig; Susanne Asenbaum; Barbara J Fueger; Andrea Hofmann; Markus Diemling; Martina Mittlboeck; Robert Dudczak Journal: Clin Endocrinol (Oxf) Date: 2003-11 Impact factor: 3.478
Authors: Mohamed M Elsebaei; Haroon Mohammad; Mohamed Abouf; Nader S Abutaleb; Youssef A Hegazy; Adel Ghiaty; Lu Chen; Jianan Zhang; Satish R Malwal; Eric Oldfield; Mohamed N Seleem; Abdelrahman S Mayhoub Journal: Eur J Med Chem Date: 2018-02-12 Impact factor: 6.514