A confused patient with raised anti-thyroid antibodies - an unusual case

摘要

Case presentation A 69-year-old Caucasian female was admitted with a four-day history of acute confusion, behavioural change and reduced responsiveness. Her past medical history was only of mild osteoarthritis and she was not on any regular medications. She was a lifelong non-smoker, drank no alcohol and there was no known psychiatric history of note. General examination was normal except for alopecia. There was no visible or palpable thyroid swelling. She was afebrile with normal vital signs. Glasgow Coma Scale (GCS) was 9/15 (eyes, 2; verbal response, 3; motor response, 4) with intermittent jerking movements of upper and lower limbs. Neurological examination revealed mild generalised hypertonia with symmetrically brisk reflexes. Corneal and gag reflexes were intact. Plantars were flexor bilaterally. The rest of her systemic examination was unremarkable.