A case of Steroid Responsive Encephalopathy associated with Autoimmune Thyroiditis: A Diagnostic Dilemma

We present a case of 42 year-old female, who presented with generalized tonic-clonic seizures with altered sensorium, not responding to antiepileptic medications. She was a diagnosed case of hypothyroidism since last three years and was on replacement therapy. Her systemic examination including the neurological examination did not point to any specific diagnosis. Her routine investigations, brain imaging and CSF analysis were also within normal limits. Thyroid function test revealed raised thyroid stimulating hormone and anti-TPO antibody with normalT4 and T3 levels. Here we considered diagnosis of “Encephalopathy Associated with Autoimmune Thyroid Disease”. She was given intravenous methylprednisolone pulse to which she responded dramatically and seizures were controlled. She was discharged on oral anti-epileptics and steroids in a stable condition.