Dados do Trabalho

Título

Case report of steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT)

RESUMO

Patient S.C.D.S., 51 years old, female, started in May 2020 with gait ataxia with postural instability determining falls. Report of incoordination to handle objects, hand tremor when performing movements. Later, difficulty in balancing oneself in an orthostatic position, even at rest. There was progressive worsening over the subsequent month, requiring support to walk.
Neurological examination showed cerebellar syndrome with ataxic gait, dysmetria, dysdiadochokinesia, Romberg sign, Stewart-Holmes test, and moderate frequency and amplitude intention tremor.
Complementary tests showed thyroid hormones (TSH and free T4) within the normal range but high Anti - T.P.O. and Anti - Thyroglobulin. Skull M.R.I. without alterations.
Given the findings, the diagnosis of steroid-responsive encephalopathy associated with autoimmune thyroiditis (S.R.E.A.T.) was proposed. The patient started pulse therapy with methylprednisolone with excellent therapeutic response. In outpatient follow-up, cerebellar syndrome improved, especially in gait, with the return of the ability to walk without support.
SRAT characteristically presents as an encephalopathy in which seizures, movement disorders, and psychosis are common findings. Rarely, the disease is predominantly expressed as cerebellar ataxia, as presented in the case described. The criteria for diagnosis of this condition were established with the elevation of anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies. Patients usually have an excellent response to immunotherapies, including steroids, as corroborated in the case we describe.
Considering the atypical clinical presentation of the predominantly cerebellar S.R.A.T., the relevance of the case is reinforced.

Palavras Chave

encephalopathy ; autoimmune thyroiditis