Abstract：
Encephalopathy can be associated with autoimmune disorders such as autoimmune thyroiditis, and it can present with a wide range of neuropsychiatric manifestations. However, it rarely presents with catatonia. We present the case of a middle-aged female with Hashimoto\'s thyroiditis presenting with catatonia. A literature review of previous similar cases highlighting significant points is also included. A 48-year-old female presented to the emergency department with catatonic symptoms that had worsened over the previous 5 days. A similar condition was reported to have occurred and resolved spontaneously 3 months earlier. On examination, the patient appeared uncooperative and unresponsive. She showed typical symptoms of catatonia, with a score of 21 points on the Bush-Francis Catatonia Rating Scale. Routine tests were within normal ranges except for an elevated level of C-reactive protein and an elevated erythrocyte sedimentation rate. Computed tomography, magnetic resonance imaging, and cerebrospinal fluid analysis were all normal. An electroencephalogram showed diffuse delta-theta range slowing with no epileptiform discharges. Lorazepam was initiated but did not control the catatonic symptoms. Re-evaluation revealed thyroid swelling and elevated levels of thyroperoxidase antibodies. IV methylprednisolone was therefore initiated and produced complete resolution of the catatonic symptoms in 4 hours. The patient was discharged and prescribed prednisone 1 mg/kg daily. At follow-up, the patient continued to show complete resolution of the catatonic symptoms. It is noteworthy that the patient developed hypothyroidism 6 months after this catatonic episode for which levothyroxine 50 mcg/d was prescribed. Encephalopathy associated with autoimmune thyroiditis can initially present with catatonic symptoms in euthyroid cases. The mainstay of treatment is steroids which result in complete resolution of the catatonic symptoms.
摘要：
脑病可能与自身免疫性疾病有关，如自身免疫性甲状腺炎，它可以表现出广泛的神经精神表现。然而,它很少出现紧张症。我们介绍了一例患有桥本甲状腺炎并伴有紧张症的中年女性。还包括对以前类似案例的文献综述，突出了重要的观点。一名48岁的女性出现在急诊科，症状在过去5天内恶化。据报道，3个月前发生了类似的情况并自发解决。在检查中，患者出现不合作和无反应。她表现出典型的紧张症症状,布什-弗朗西斯·卡塔托尼亚评分表得分为21分。除了C反应蛋白水平升高和红细胞沉降率升高外，常规测试均在正常范围内。计算机断层扫描,磁共振成像，脑脊液分析均正常。脑电图显示弥漫性δ-θ范围减慢，没有癫痫样放电。开始服用劳拉西泮，但不能控制紧张性症状。重新评估显示甲状腺肿胀和甲状腺过氧化物酶抗体水平升高。因此，开始静脉注射甲基强的松龙，并在4小时内完全缓解了紧张性症状。患者出院，每天服用泼尼松1mg/kg。在后续行动中,患者继续表现出完全缓解的紧张性症状。值得注意的是，患者在这种紧张性发作后6个月出现甲状腺功能减退症，左甲状腺素50mcg/d。在甲状腺功能正常的病例中，与自身免疫性甲状腺炎相关的脑病最初可表现为紧张性症状。治疗的主要是类固醇，可完全缓解紧张性症状。
