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Hashimoto's encephalitis is a rare, heterogeneous and completely treatable form of neuroendocrine disorder manifesting with seizures, stroke-like episodes, encephalopathy, dementia and variable neuropsychiatric manifestations. It is generally associated with a background of Hashimoto's Thyroiditis, and the patient has high titers of antithyroid antibodies, especially antithyroid peroxidase antibodies. This entity responds dramatically to corticosteroids, hence should be always considered and excluded while treating a patient with encephalopathy in the background of a thyroid disease.

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Background:The early prediction of acute kidney injury (AKI) by the current clinical and laboratory methods remains inadequate. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising noninvasive biomarker of kidney injury in shock. The aim of this study was to assess the ability of urinary NGAL (uNGAL) to predict AKI in adult Intensive Care Unit (ICU) patients.Materials and Methods:We prospectively studied 70 patients with circulatory shock admitted to the ICU over a period of 1 year. uNGAL was analyzed at ICU admission and after 24 h. Risk, injury, failure, loss, and end-stage kidney criteria were calculated at admission and for consecutive 4 days. The primary outcome was AKI defined as an increase in creatinine of at least 50% from baseline or a reduction in urine output to <0.5 ml/kg/h for 6 h.Results:uNGAL was a good diagnostic marker for AKI development; at day 1, the cutoff value 48.54 ng/mL had a sensitivity and specificity of 79.49 and 73.14, respectively, and the area under the curve (AUC) of 0.82 (95% confidence interval [CI], 0.75–0.87) for predicting AKI. At day 2, the cutoff value 190.92 ng/mL had a sensitivity and specificity of 90.0 and 64.66, respectively, and the AUC of 0.76 (95% CI, 0.70–0.88) for predicting AKI.Conclusion:uNGAL could be a good early predictor biomarker of AKI following circulatory shock.

CASE REPORTThyrotoxic periodic paralysis (TPP) is an uncommon disorder characterized by simultaneous thyrotoxicosis, hypokalaemia, and paralysis and is the most common acquired form of periodic paralysis. It is usually associated with low plasma potassium levels and is often precipitated by physical activity or ingestion of carbohydrates. We presented a 35-year-old man with hyperthyroidism who admitted applied to the emergency department with an episode of flaccid quadriparalysis following oral diclophenac sodium usage for lumbar disk hernia and the review of the literature on this subject. Physical and laboratory examination revealed sinus tachycardia, diffuse toxic goiter, flaccid quadriparalysis, a low serum potassium level (1.51 mmol/L), ST segment depression, coincidental horseshoe kidney. Potassium chloride was admitted via both parenteral and orally. Meanwhile antithyroid treatment (propylthiouracil and propranolol) was also given. Early diagnosis is important for planning antithyroid treatment, protecting the patient from further episodes of paralysis and avoidance of precipitating factors. In our patient, electrolyte imbalance appeared secondary to polyuria and vomiting, serious pain and physical stress may have triggered TTP.