Hashimoto encephalopathy induced by coronavirus

Abstract

Background: Multiple factors can induce thyroid disease. The mechanism is not precise; a possible mimicry effect in the thyroid tissue could be the cause. Encephalopathy could be one manifestation of this thyroid disorder, but its mechanism is not well understood. There is a lack of data showing coronavirus as a possible cause of Hashimoto encephalopathy. Case Report: A 34-year-old obese Hispanic female was brought to our emergency department due to acute “Behavioral changes”. Her family noted her anxiety with repetitive head movement.; the patient presented with psychotic behavior, reporting family members were killed (The same that brought her), having auditory hallucinations; the family could not precisely predict the duration of this behavior. Her history includes asthma (never intubated, not on steroids), morbid obesity, galactorrhea, and extensive HTN and DM. She denied chest pain, palpitations, nausea, vomit, fever, malaise, recent flu-like symptoms. No abnormality in the physical examination was noted except for repetitive head movement; due to her acute mental status changes and lactic acidosis, she was admitted under critical care service. During her admission, the TSH/T3/ T4: 47.10/34/0.15, Antimicrosomal Ab and Coronavirus PCR were positive (Table1); CXR: No acute pathology, CT Head: Unremarkable, ultrasound neck showed Enlarged heterogeneous thyroid gland, which limits evaluation of underlying parenchyma; no measurable demonstrated solid, cystic or complex nodule (Figure 1). MRI head showed no pituitary adenoma. The patient was started on levothyroxine initially IV then transitioned to 200 mcg PO, and received ceftriaxone, dexamethasone, enoxaparin (As prophylaxis) for C19; after thyroid replacement was initiated; the patient started improving mental status drastically, she was transferred to the medical floor, later improved to baseline, and then was discharged. As an outpatient, the repeated thyroid panel showed normal values, and mental status was status as her baseline previous to her admission. Conclusion: Our case report describes a case of Hashimoto encephalopathy induced by SARS-CoV2 virus. Besides reports relating this thyroiditis with viral other viral entities, there is no data about this thyroid disorder in the 2020 pandemic.