AN UNUSUAL PATIENT WITH HASHIMOTO THYROIDITIS, FEATURES OF STEROID-RESPONSIVE ENCEPHALOPATHY ASSOCIATED WITH AUTOIMMUNE THYROIDITIS, AND CONCURRENT MINIMAL CHANGE RENAL DISEASE

ABSTRACT Objective: To present an unusual patient with Hashimoto thyroiditis, encephalopathy with features of steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), and acute kidney injury secondary to minimal change renal disease. Methods: We present clinical, laboratory, imaging, electroencephalography, and renal histopathologic findings, and review the relevant literature for evaluation and treatment of SREAT. Results: A 53-year-old woman with a history of hypothyroidism on levothyroxine was admitted for progressive altered mental status and bizarre behavior for 3 weeks. On exam she was lethargic with myoclonic jerks, hypertonia, and hyperreflexia. Laboratory analyses showed thyroid-stimulating hormone of 0.057 μU/mL (normal, 0.27 to 4.0 μU/mL), free thyroxine of 1.5 ng/dL (normal, 0.7 to 1.5 ng/dL), triiodothyronine of 0.7 ng/mL (normal, 0.6 to 1.6 ng/dL), and elevated anti–thyroid peroxidase (>600 U/L) and antithyroglobulin (57.2 U/L) antibodies. The patient failed to impro...