Primary hypothyroidism masquerading as hepatic encephalopathy: case reportand review of the literature

A 74 year old woman with hepatitis C of long duration was admitted to hospi tal in hyperammonaemic coma. Despite aggressive treatment of hepatic enceph alopathy, there was no clinical improvement. As part of her evaluation for other causes of altered mental status, she was found to be profoundly hypot hyroid. Treatment with thyroid replacement hormone was accompanied by promp t normalisation of her mental status and hyperammonaemia. Hypothyroidism ma y exacerbate hyperammonaemia and portosystemic encephalopathy in patients w ith otherwise well compensated liver disease. Hyopthyroidism should be cons idered in the differential diagnosis of encephalopathy in patients with liv er disease.