橋本氏腦病變以呆滯、緘默和拒食為表現：案例報告

Symptoms of Stupor, Mutism and Food Refusal Presented in Hash imoto’s Encephalopathy: A case report

橋本氏腦病變（Hashimoto’s encephalopathy; HE）是一種罕見的自體免疫 疾病，若以精神病症狀呈現，常為幻覺、妄想和行為改變等，易被誤診為思覺失調 症，如其臨床呈現不典型症狀或藥物療效不佳，進一步鑑別診斷時，須將橋本氏腦 病變等生理疾患所致之精神疾病納入鑑別診斷，以減少個案認知功能損害。本個案 是一位30 歲女性，因自笑及激躁，疑似思覺失調症而入院，住院後其進展至呆滯、 緘默、拒食等僵直症症狀，然而經抗精神病藥物治療效果不佳，詳細檢查發現其抗 甲狀腺抗體（Anti-TPO ＆ Anti-Tg）呈現陽性反應，排除其他生理疾患後，臨床診 斷為橋本氏腦病變，據此開始以類固醇治療後，個案精神症狀與認知功能明顯改 善，恢復自我照顧能力。

 

Hashimoto’s encephalopathy is a rare and easily misdiagnosed autoimmune disease, with neuropsychiatric symptoms and elevated thyroid antibodies as common presenting symptoms. Psychiatric manifestations are easily diagnosed as schizophrenia with hallucinations, delusions, and behavioral changes. Therefore, to prevent misdiagnosis and achieve better prognosis through early diagnosis and correct treatment, differential diagnoses should be conducted for patients manifesting atypical psychotic symptoms to distinguish psychotic disorder due to physiological conditions, such as Hashimoto’s encephalopathy. Our case is a 30-year old female patient who received a tentative diagnosis of schizophrenia on admission.
She gradually progressed to catatonic symptoms of stupor, mutism and foodrefusal. Further tests indicated elevated thyroid antibodies in both anti-thyroid peroxidase antibodies (anti-TPO) and anti-thyroglobulin antibodies (anti-Tg). Additional examinations excluded other potential organic factors contributing to her illness. With the impression of Hashimoto’s encephalopathy, the patient was treated with corticosteroid, upon which both her clinical symptoms and self-care soon improved.