Acute psychosis secondary to steroid responsive encephalopathy associated with autoimmune Hashimoto's thyroiditis

Abstract

Approach to Hashimoto thyroiditis encephalopathy.

Hashimoto’s Thyroiditis Presents as an Acute Encephalopathy: A Case Report of Unusual Presentation

“…There is a broad spectrum of presenting manifestations; however, encephalopathy manifesting with abrupt confusion with an altered level of consciousness is the hallmark presentation [8,10]. Two patterns of cognitive dysfunction are predominant; a stroke-like pattern which is more acute to subacute, and a gradual diffuse progressive pattern which might result in dementia, hallucination, or even lethargy, progressing to coma in extreme cases [8,10].…”

“…Accompanying non-cognitive symptoms include seizure (in approximately two-thirds of patients), myoclonus (seen in up to 38%), loss of consciousness [10], tremors, hyperreflexia, poor appetite, ataxia, and dysarthria [8]. Besides, psychosis, in the form of paranoid delusion and visual hallucinations, has been reported in 25%-36% [4,8].…”

“…Analysis of CSF should be performed; the most common findings are elevated proteins and less commonly pleocytosis [13]. Thyroid hormones should be measured; however, normal values do not exclude HE diagnosis [10]. EEG may detect generalized slowing related to encephalopathy or the presence of subclinical seizure activity.…”

Anti-N-Methyl-D-Aspartate Receptor Encephalitis (ANMDARE) in a Patient With Hashimoto’s Thyroiditis

“…This finding, along with the acute or subacute onset of neurological or psychiatric symptoms, is characteristic of HE. The clinical presentation is frequently more insidious, with the pathognomic feature of HE being altered mental status, which presents as confusion with or without psychosis, seizures, myoclonus, or loss of consciousness [9][10].…”

“…There are two patterns of cognitive dysfunction present in HE: an acute to subacute stroke-like pattern and a more progressive, gradual pattern resulting in dementia, hallucination, or coma [9]. ANMDARE and HE share similar clinical features, so differential diagnosis can be difficult if specific antibodies are not tested.…”