DOI: https://doi.org/10.21203/rs.3.rs-1813984/v1
We report a case diagnosed metabolic encephalopathy following Hashimoto's thyroiditis whose MRI shown persistent symmetrical bilateral hypertension on DWI in the past two years. To our knowledge this is the first report of persistent symmetrical bilateral hypertension on DWI in a patient with Hashimoto's thyroiditis.
A70-year-old women with a 5-year history of Hashimoto's thyroiditis presented with recurrent consciousness disturbance in the past 15 days. She also had a history of dizziness and gait instability for 3 years who took twice examinations of magnetic resonance imaging (MRI) in the past two years. She’s medical history involved taking dextrothyroxine for the treatment of the Hashimoto's thyroiditis. But she stopped taking dextrothyroxine in the past month. She received intranasal dextrothyroxine and intravenous use of corticosteroid. The next day her awareness restored to normal. Neurological examination revealed symmetric weakness of all 4 limbs and ataxic gait.
Laboratory testing showed decreased free triiodothyronine(3.12pmol/l); elevated antithyroid peroxidase antibody(64.4IU/ml), thyroglobulinantibody(6.1IU/ml) and thyroid stimulating hormone(15.049uIU/ml); elevated blood ammonia(141ummol/L) ; decreased VB12(63.00pg/ml).
Head magnetic resonance imaging showed symmetrical bilateral hypertension on diffusion -weighted imaging (DWI) and T2-weighted imaging (Figure1). Compared with the two previous MRI in the past two years, we found the symmetrical bilateral hypertension on DWI exist persistently. T2-weighted MRI findings the lesion of the cerebellar peduncle presented as “mushroom cloud” changes (Figure 3).
Persistent hypertension on DWI can present in Adult Leukodystrophies, adult-onset neuronal intranuclear inclusion disease (NIID) and CJD.1,2,3,4But it differs from the above diseases in our patient by the character of the DWI. We consider the likely of the Hashimoto encephalopathy in our patient due to the history of Hashimoto's thyroiditis, high levels of antithyroid peroxidase antibody and sensitive to cortisol. And the high blood ammonia play role in the consciousness disturbance. But the persistent symmetrical bilateral hypertension on DWI has not been reported in the Hashimoto encephalopathy.
Ethics approval and consent to participate
Informed consent was obtained from the patient to publish his case, and approval for
this study was provided by the Research Ethics Committee of The Second Hospital of
Liaocheng.
Consent for publication
Written informed consent for publication of this Case Report was obtained from the
patient.
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All data related to this case report are documented within this manuscript
Competing interests
The authors declare that they have no competing interests.
Funding 1
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Authors’ contributions ZSL and PXX contributed to the concept, drafting, and
reporting of the case. PYH contributed to revision of the manuscript. All
authors have read and
approved the final manuscript.
Acknowledgments
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Competing Interest:
The authors have no conflicts of interest to disclose
Contributions: Shu-lai Zhu: Drafting/revision of the manuscript for content, including medical writing for content; Analysis or interpretation of data;
Xin-xin Pan: Drafting/revision of the manuscript for content, including medical writing forcontent; Major role in the acquisition of data;
Yu-hua Peng: Drafting/revision of the manuscript for content, including medical writing for content;