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ENCEPHALOPATHY TREATED AFTER SURGERY FOR GRAVES' DISEASE.

I N El Ibrashy1, H M El Haddad1, A M ElMeligi1

  • 1Dept. of Internal Medicine, "Kasr Alainy" Cairo University, Faculty of Medicine, Cairo, Egypt.

Acta Endocrinologica (Bucharest, Romania : 2005)
|August 17, 2022
PubMed
Summary

Total thyroidectomy effectively resolved recurrent Graves encephalopathy (GE) attacks in a patient resistant to medical treatment. This surgical option should be considered for severe, uncontrolled GE cases, as antibody levels may not reflect treatment success.

Keywords:
Hashimoto’s thyroiditisautoimmunecognitive functionthyroid disease

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Area of Science:

  • Neurology and Endocrinology
  • Autoimmune Diseases
  • Surgical Case Reports

Background:

  • Graves encephalopathy (GE), a rare neurological manifestation of autoimmune thyroid disease, presents significant management challenges.
  • Standard medical therapies, including steroids, often fail to prevent relapses in severe GE cases.
  • This report details the fourth case of GE requiring surgical intervention.

Observation:

  • A 33-year-old male with recurrent Graves' disease experienced five severe GE relapses within 17 months, necessitating intensive care.
  • Despite aggressive medical management, neurological symptoms persisted, indicating treatment resistance.
  • The patient underwent urgent total thyroidectomy following a severe relapse.

Findings:

  • Total thyroidectomy led to complete resolution of GE attacks during an 18-month follow-up period.
  • Post-thyroidectomy, the patient remained free of neurological episodes, demonstrating the efficacy of the surgical approach.
  • Elevated thyroid antibodies persisted despite clinical improvement, suggesting they are not a reliable indicator of treatment success in GE.

Implications:

  • Total thyroidectomy is a viable and effective treatment option for medically refractory Graves encephalopathy.
  • Consideration of thyroidectomy in treatment protocols for uncontrolled GE is warranted.
  • Clinical outcomes, not solely antibody titers, should guide the assessment of treatment effectiveness in GE.