Unusual case of Hashimoto’s encephalopathy and pseudo-obstruction in a patient with undiagnosed hypothyroidism: a case report

INTRODUCTION: Hashimoto’s encephalopathy is a relatively rare condition associated with an elevated concentration of circulating serum anti-thyroid antibodies, and is usually responsive to steroid therapy. However, hypothyroidism is a rare cause of pseudo-obstruction so here we present a case report of Hashimoto’s encephalopathy with gut pseudo-obstruction in an undiagnosed hypothyroid patient. CASE PRESENTATION: A diagnosis of unknown aetiology of encephalopathy with gut dysmotility in an undiagnosed profound hypothyroidism case associated with cognitive decline and behavioural disorder was made in a 60-year-old Indian man. The associated clinical and laboratory features led to the final diagnosis of overt hypothyroidism with Hashimoto’s encephalopathy with gut pseudo-obstruction. CONCLUSIONS: Hashimoto’s encephalopathy is a rare disorder presenting with acute or sub acute encephalopathy of unknown aetiology so there are considerable chances of misdiagnosing it. The unusualness of this case is that since hypothyroidism is a rare cause of intestinal pseudo-obstruction, and presented concomitant with Hashimoto’s encephalopathy, that itself is a rare entity. Intestinal pseudo-obstruction is a potentially serious complication that must be recognized and treated promptly with adequate thyroid hormone therapy.