ENCEPHALOPATHY TREATED AFTER SURGERY FOR GRAVES' DISEASE

Abstract

Introduction: This case report is the fourth of its type in the medical literature. It describes total thyroidectomy for recurrent relapses of Graves encephalopathy (GE) despite medical treatment.

Case presentation: A 33-year-old male presented with impaired consciousness and convulsions. He had post-thyroid surgery recurrent Graves' disease with a goitre. Based on this fact, high thyroid antibodies titres and the exclusion of other causes of such neurological manifestations, he was diagnosed to have GE. This is a rare variant of "encephalopathy associated with autoimmune thyroid disease" (EAATD). Despite the administration of steroid therapy and other standard therapeutic measures, he developed five relapses within 17 months. Total thyroidectomy was advised. Unfortunately, he got another severe attack that required intensive care admission. After three days of discharging, he had urgent total thyroidectomy. The operation went well and for 18 months' follow-up he had no more attacks. However, thyroid antibodies remained high.

Discussion: The report provides details on the diagnosis, standard management and the indication for thyroidectomy for GE. It describes its challenges, precautions, technique and outcomes. It reviews the extent of surgery as well as the clinical and antibody outcomes of the previous three related reports, in comparison with the current one.

Conclusion: For medically uncontrolled relapse of GE, thyroidectomy consistently results in ending the attacks. It, therefore, should be put in more consideration in the treatment protocols. On the other hand, one should not depend on antibody levels as a measure of treatment success.

Keywords: Hashimoto’s thyroiditis; autoimmune; cognitive function; thyroid disease.