In each case, the patient exhibited a minimal response to steroids,
plasmapharesis, and IVIG. Both patients underwent total thyroidectomy
after informed consent was given for the procedure. Their responses
to the surgery, however, were mixed. The first patient continued to
display neurological signs such as tremor and motor agitation, but this
was slightly improved at the time of her discharge. Following release
from the hospital, she continued to lose ability to care for herself
independently. Her mental status and ability to follow commands never
recovered. In contrast, the second patient’s intractable seizures remitted
completely after thyroidectomy including drastic improvement on
EEG. In addition, her cognitive status improved as she reacquired the
abilities of naming, repetition, and comprehension at later follow-up. A
possible explanation for the difference in clinical improvement between
patients is the thyroid tissue remnant found in the first patient during
a follow-up iodine-123 thyroid scan. This finding confirms that not
all thyroid tissue was removed during thyroidectomy, and the tissue
remnant could be responsible for her persistently elevated anti-thyroid
antibodies.