TPO and Cognitive impairment: Tang et al., in their study, applied the extended criteria for HE, which included encephalopathy manifested by clouding of consciousness, cognitive impairment, seizures or neuropsychiatric features, and elevated anti-TPO antibodies with euthyroid status (serum-sensitive thyroid-stimulating hormone [TSH], 0.35–5.5 uIU/mL).