Abstract

Hashimoto's encephalopathy (HE) is a neuropsychiatric condition characterised by elevated thyroid autoantibodies and an exquisite responsiveness to steroids. Patients may present with acute encephalopathic, chronic psychiatric, ataxia, CJD-like and limbic encephalitis symptoms. We report here, for the first time, a case of HE presenting with profound, refractory and recurrent hypothermia.

A 58-year-old lady was admitted following an episode of slurred speech. At presentation GCS was 15, with a temperature of 28C and pulse of 35–45 bpm. She later developed progressive slurring dysarthria, and worsening paranoid ideation and delusions. Despite active warming with bear huggers, she remained hypothermic. 11 days after admission, her GCS dropped to 5, so was intubated and ventilated.

The TPO antibody was raised at 507IU (normal 0–59IU). A diagnosis of HE was made and she responded dramatically to IV methylprednisolone. While rehabilitating on the ward one month later, her temperature fell to 33.5C and within 24 hours she was paranoid and agitated. A relapse of the HE was suspected. After a further course of IVMP, her temperature normalised, and confusion resolved within 36 hours.

This case further expands the clinical phenotype of Hashimoto's encephalopathy. Furthermore it bears clinical similarities to disorders of hypothalamic dysfunction both traumatic, chronic inflammatory, and that after clonidine toxicity suggesting a possible target for future investigations.