A Case of Autoimmune Thyroiditis Presenting as Apraxia

Autoimmune thyroiditis, commonly referred to as Hashimoto's thyroiditis, is the leading cause of hypothyroidism in iodine-sufficient regions. Neurologic manifestations are uncommon.

A 20-year-old female with no significant medical history presented with aphasia and episodes of nonsensical speech. Initial workup was unremarkable, and she was discharged. She subsequently returned with recurrent neurologic symptoms, including apraxia and headache. Further evaluation revealed an elevated thyroid-stimulating hormone (TSH) level and markedly elevated antithyroid peroxidase (anti-TPO) antibodies. A diagnosis of autoimmune thyroiditis was made, and treatment with levothyroxine led to improvement in symptoms.

Autoimmune thyroiditis can have atypical presentations, particularly in younger individuals. Genetic predisposition and family history may increase susceptibility. Early recognition is critical in identifying cases such as Hashimoto's encephalopathy, which may resolve completely with appropriate treatment.

We present a case of autoimmune thyroiditis that manifested solely with neurological symptoms. It is crucial to consider hypothyroidism when treating complex, undifferentiated patients.