Clinical Response to Thyroidectomy in Three Cases of Refractory Hashimoto’s Encephalopathy—a Potential Therapy

Hashimoto’s thyroiditis is a common endocrine disorder. Clinical presentation in Hashimoto’s thyroiditis is predominantly due to associated hypothyroidism with or without goiter-related neck complaints. Rarely, HT can be associated with recurrent encephalopathy characterized by seizures, amnesia, and comatose episodes. The treatment for this enigmatic disease is symptomatic and supportive with no curative option. There are meager, anecdotal reports on the role of thyroidectomy as a treatment option. In this context, we report our experience on impact of total thyroidectomy on Hashimoto’s encephalopathy, refractory to anti-epileptic medications and steroids. This is a retrospective study conducted in an endocrine surgery department of a tertiary care hospital. Three patients with Hashimoto’s encephalopathy are included in this study. All the clinico-investigative and operative data are scrutinized and analyzed. All of them underwent uneventful total thyroidectomy. Written informed consent was obtained in all cases. Mean follow-up after surgery was 1.6 SD 0.8 years (1.2–2.8). Mean age was 46 ± 6.4 years (39–52). None of the patients had associated hypertension, migraine, diabetes, or any other neurological illnesses. The mean preoperative serum anti-thyroperoxidase antibody level was 445 SD 106.2 IU/L (370–700), which was above the upper reference limit of 60 IU/L and post-operative level was 62.75 SD 34 IU/L (32–104). There was complete remission of seizure attacks in all the cases till the last follow-up period. Total thyroidectomy appears to be a viable curative option for refractory Hashimoto’s encephalopathy. Anti-thyroperoxidase antibody-related autoimmunity appears to play a role in Hashimoto’s encephalopathy etiologic cascade. Long-term impact and multi-institutional results are required to validate the curative role of surgery in this condition.