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Case No. 755
2026-06-01~2026-06-30
출제자 : 이경미
Hit : 476
| Period | 2026-06-01~2026-06-30 |
|---|---|
| Diagnosis | Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis (SREAT) |
| Clinical information | C.C> headache Lab> Increased T3, T4, TBII, TG-Ab, TPO Ab Decreased THS |
| Discussion | Rare, treatable autoimmune disorder characterized byacute or subacute encephalopathy,high serum anti-thyroid antibodies (especially anti-TPO),rapid response to corticosteroids Pathophysiology:believed to be an autoimmune-mediated inflammatory disease,possibly involving cerebral vasculitis or cross-reactive antibodies between thyroid and brain tissue Clinical Presentation:mild confusion, memory impairment, and psychiatric disturbances (hallucinations, paranoia),severe manifestations like status epilepticus, coma, and stroke-like episodes Diagnosis: encephalopathy: seizures, confusion, psychiatric symptoms, stroke-like episodes elevated anti-thyroid peroxidase (TPO) antibodies often accompanied by elevated anti-thyroglobulin (TG) antibodies even when the patient is euthyroid Treatment: high-dose corticosteroids (first-line treatment) : usually result in significant improvement in cases of steroid resistance or relapse : alternative therapies like intravenous immunoglobulin (IVIG) or plasma exchange (plasmapheresis) Imaging: Brain MRI, often normal may show generalized cerebral atrophy non-specific T2/FLAIR white matter signal changes acute diffusion-weighted imaging (DWI) changes in some cases ++SREAT should be considered in any patient presenting with unexplained encephalopathy, especially if thyroid autoimmunity is present |
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