# Hashimoto Encephalopathy and Thyroid Storm by Diabetic Ketoacidosis and Acute Pancreatitis: A Case Report

## TL;DR

A 69-year-old woman with diabetes and thyroid disease developed Hashimoto encephalopathy and thyroid storm after diabetic ketoacidosis and acute pancreatitis, highlighting a rare but important clinical connection.

## Contribution

This case report highlights the rare co-occurrence of Hashimoto encephalopathy and thyroid storm following diabetic ketoacidosis and acute pancreatitis.

## Key findings

- The patient tested positive for anti-thyroid antibodies and anti-NAE antibodies during the acute phase of thyroid storm.
- Treatment with steroids, potassium iodide, and thiamazole led to recovery of daily functioning.
- The case suggests that Hashimoto encephalopathy should be considered in thyroid storm cases with central nervous system symptoms.

## Abstract

Hashimoto encephalopathy (HE) is a rare condition related to autoimmune origin characterized by high titers of antithyroid antibodies. Steroids are effective for treatment of HE, suggesting the autoimmunity as an underlying mechanism. In addition, anti-NH2-terminal of α-enolase antibodies (anti-NAE antibodies) is useful for diagnosis of HE. This report describes a 69-year-old woman developing both HE and thyroid storm (TS), following diabetic ketoacidosis (DKA) and acute pancreatitis. She had a history of Basedow’s disease and uncontrolled type 2 diabetes mellitus, and her serum hemoglobin A1c was 10%. She complained of nausea and visited our hospital. She was diagnosed with DKA and acute pancreatitis. After admission, she went into cardiopulmonary arrest and she was diagnosed with TS after resuscitation. In addition, blood test collected during acute phase of TS revealed positive for not only anti-thyroid peroxidase (TPO) antibodies, thyroid stimulating hormone receptor antibodies and thyroid stimulating antibodies, but also anti-NAE antibodies. She was treated with intravenous steroids, potassium iodide and thiamazole under respirator and recovered sufficiently to do daily activities of life. We should keep in mind that there might be cases of HE in cases of TS presenting with central nervous system symptoms.