{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:44Z","timestamp":1756425824825,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,12,6]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>We report a case of a woman in her mid-20s presenting with encephalitis as the initial presentation of type 2 amiodarone-induced thyrotoxicosis (AIT). She was on amiodarone in view of a history of hypertrophic cardiomyopathy. Symptomatology included acute personality change and focal myoclonic jerks.<\/jats:p>\n               <jats:p>Cerebrospinal fluid analysis showed a non-specific protein count elevation with negative microbiology, virology, autoimmune screen and onconeural antibodies. The electroencephalogram was consistent with a generalised cerebral dysrhythmia. An MRI of the head revealed symmetrical oedema within the motor cortices and a high T2 signal within the cerebellar dentate nuclei, with no restricted diffusion. Blood investigations confirmed thyrotoxicosis with negative antithyroid antibodies. She did not fulfil the criteria for a thyroid storm. Other possible causes of encephalitis were excluded.<\/jats:p>\n               <jats:p>There was an excellent clinical, laboratory and radiological response to glucocorticoids, suggesting a diagnosis of steroid-responsive encephalitis secondary to type 2-AIT in the absence of a thyroid storm.<\/jats:p>","DOI":"10.1136\/bcr-2023-257731","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T13:15:25Z","timestamp":1703078125000},"page":"e257731","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Encephalitis as an initial presentation of type 2 amiodarone-induced thyrotoxicosis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7125-736X","authenticated-orcid":false,"given":"Kyle","family":"Cilia","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Mifsud","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Craus","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandro","family":"Vella","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Dingli","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,12,20]]},"reference":[{"key":"2025082802522839000_16.12.e257731.1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.60.2.164"},{"key":"2025082802522839000_16.12.e257731.2","article-title":"Steroid-responsive encephalopathy associated with autoimmune thyroiditis presenting with fever and confusion","volume":"2017","author":"Liyanage","year":"2017","journal-title":"Case Rep Neurol Med"},{"key":"2025082802522839000_16.12.e257731.3","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2377-10-27","article-title":"Encephalopathy associated with autoimmune thyroid disease in patients with graves' disease: clinical manifestations, follow-up, and outcomes","volume":"10","author":"Tamagno","year":"2010","journal-title":"BMC Neurol"},{"key":"2025082802522839000_16.12.e257731.4","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000071"},{"key":"2025082802522839000_16.12.e257731.5","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.54.3.769"},{"key":"2025082802522839000_16.12.e257731.6","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1111\/ene.14657","article-title":"Patients with a relapsing course of steroid-responsive encephalopathy associated with autoimmune thyroiditis exhibit persistent intrathecal CD4+ T-cell activation","volume":"28","author":"Pfeuffer","year":"2021","journal-title":"Eur J Neurol"},{"key":"2025082802522839000_16.12.e257731.7","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.63.2.197"},{"key":"2025082802522839000_16.12.e257731.8","doi-asserted-by":"publisher","DOI":"10.1007\/BF00900946"},{"key":"2025082802522839000_16.12.e257731.9","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2004.049395"},{"key":"2025082802522839000_16.12.e257731.10","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2019.00324","article-title":"Application of plasma exchange in steroid-responsive encephalopathy","volume":"10","author":"Jiang","year":"2019","journal-title":"Front Immunol"},{"key":"2025082802522839000_16.12.e257731.11","unstructured":"Pokhrel B , Aiman W , Bhusal K . Thyroid Storm. StatPearls Publishing, 2022."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-257731","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:52:40Z","timestamp":1756374760000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-257731"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":11,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,20]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/bcr-2023-257731"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-257731","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}