A 52-year-old female patient with Hashimoto encephalopathy was admitted to hospital for clinical treatment, and the findings on MR spectroscopy (MRS) and MR imaging (MRI) in the brain were reported. MRS revealed the decreases in N-acetylaspartate (NAA/Cr=1.19) and myo-inositol peaks, and the elevations in lipid, lactate, glutamate/glutamine multiplet and choline (Cho/Cr=1.21) peaks which supported a cerebral inflammatory change, in addition to multifocal hyperintensities on T2WI and fluid-attenuated inversion recovery (FLAIR) images, slight hyperintensities on diffusion weighted imaging (DWI), hypointensities on T1WI. The atrophy of the brain was revealed on follow-up MRI two years later.