Friday, October 26, 2007

Default Hashimoto Encephalopathy? Please help!

I'm looking for any advise on HE situation, I think my mother has this decease.

My mother (66 years old) had Hashimoto thyroiditis for a long time and it was not diagnosed or treated. Her nails got very yellow and thick and hair were thinning. She was loosing weight and getting more and more tired, but was able to work as a dentist, her mental state was absolutely normal.

But in May in a period of 2-3 days she developed neurological symptoms: right sided hemi paresis, confusion, aphasia, tremor, myoclonus, limbs twitching and rigidity that were progressing. Her TSH at a time was 18 and TPO 380. Doctors could not come up with a diagnose, all tests were fine(MRI, EEG, spinal, virus and toxicity tests) and by the end of the month she got into stupor, had myoclonic seizures and then was in coma for 2 days. In reanimation she regained complete consciousness, was absolute adequate, normal and stayed symptoms free for 2 months. In August the same set of neurological symptoms occurred - gait unsteadiness, right sided hemi paresis, confusion, delirious-like state, extreme rigidity and then myoclonic convulsions. Her TSH is 23 now and TPO is 647, she was put on Syntroid(88mg) and was getting better physically for past week and a half, she can walk, talk, eat. However, her thinking is still very clouded, she's disoriented and have difficulty expressing herself, she has no short term memory at all.

Neurologist and psychiatrist are saying that this is due to hypothyroid, but endocrinologist says that mom's TSH is not high enough for mexedema delirium(plus, mom has no swelling or goutier, she actually lost a lot of weight).
But I was doing a lot of reading on what can cause her relapsing condition and Hashimoto Encephalopathy came up - mom's symptoms look very much like HE. In this case, as I understand, Levothiroxin alone will not help. But last week she was discharged from hospital and IV steroid treatment was not prescribed. Now endocrynologist saying that she might consider oral steroid treatment with high doses of Prednisone for my Mom, but all case studies on HE I've read mention IV pulse steroid theraphy as a choice of treatment, they state remarcble response occure in 1-3 days in case ir this is really HE.
Did anyone improve on oral steroids, did it help?

I'm looking for any advise on the HE, please, help! How do I talk doctors into considering probability of HE for my mom?