Abstract Background: Hashimoto’s encephalopathy (HE) is a complication of autoimmune thyroiditis, rarely seen in the pediatric age group. Clinical Description: Case 1: An 11-year-old boy presented with acute-onset hypersomnolence and behavioral changes, with no fever, seizures, or cognitive decline. Examination was largely unremarkable, except a drowsy state. Case 2: A 14-year-old girl presented with a 3-month history of production of vocal sounds, misdiagnosed as cough. There was no associated altered sensorium, fever, or dysphagia. Examination was unremarkable. Management and Outcome: Baseline routine investigations were normal in both cases. Case 1 was found to have hypothyroidism, while Case 2 was euthyroid. Both had elevated anti-thyroid antibodies. Investigations ruled out other possible causes. Brain imaging was normal, but electroencephalogram showed seizure activity in Case 1. In Case 2, neck ultrasound revealed diffuse heterogeneous thyromegaly. Considering a complication of autoimmune thyroiditis, both cases were treated with steroids. In addition, Case 1 received thyroxine supplements for hypothyroidism and on follow-up azathioprine as steroid sparing agent. Both cases showed dramatic improvement by 1 week and 4 days, respectively, thus confirming the diagnosis of HE. Conclusion: This report highlights two rare pediatric presentations of Hashimoto’s thyroiditis, in the form of neuropsychiatric manifestations including vocal tics, underscoring the diagnostic complexity and potential for delayed recognition.
Ezhilpriya et al. (Wed,) studied this question.