Hashimoto’s encephalopathy is a rare disorder with an estimated
prevalence of 2.1/100,000 [8]. Treatment of this condition with total
thyroidectomy has been reported only once in the literature to date
[3]. Yuceyar et al. [3] reported a 31-year-old female with HE who
underwent thyroidectomy after partial response to medical treatment
and achieved full recovery. A notable difference is that the patient was
thyrotoxic in contrast to our patients who were euthyroid. The patient’s
thyroid peroxidase antibody (up to 600 IU/mL) was elevated to a much
greater degree than both of our patients, but her anti-thyroglobulin
antibody level (up to 394 IU/mL) was comparable. Given that this
patient experienced full recovery after thyroidectomy, it does not seem
that significant preoperative antibody elevation precludes a clinical
response to thyroidectomy. Taking our two cases into account, the
degree or pattern of preoperative antibody elevation does not seem to be
predictive of postoperative response. It is worth noting that for both of
our patients, the thyroid peroxidase antibodies remained significantly
lower than anti thyroglobulin antibodies, while the converse was true in
the previously reported case referenced above.