ENCEPHALOPATHY TREATED AFTER SURGERY FOR GRAVES' DISEASE.

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.