Anti-N-methyl-D-aspartate receptor encephalitis in a young female with subclinical hypothyroidism associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies: A case report

Abstract

Anti- N-methyl-D-aspartate receptor encephalitis is a life-threatening medical emergency that can be clinically misperceived as Hashimoto’s encephalopathy. We present a case of anti- N-methyl-D-aspartate receptor encephalitis in an otherwise healthy young female with subclinical hypothyroidism without an associated ovarian teratoma. She was first misdiagnosed as Hashimoto’s encephalopathy due to delirium and behavioral changes, seizures, psychosis, and increased amount of thyroid peroxidase and thyroglobulin antibodies in serum. Final diagnosis was established by third week following presentation with the detection of anti- N-methyl-D-aspartate receptor antibodies in her cerebrospinal fluid. After treatment with intravenous immunoglobulin, methylprednisolone, and amisulpride, she recovered significantly with minimal sequelae at 3-week follow-up.

Low triiodothyronine (T3) levels predict worse outcomes in autoimmune encephalitis—A meta‐analysis of current literature

“…Antibodies have been found against TSH receptor (TRAb), thyroid peroxidase (TPOAb), and thyroglobulin (TgAb) (Vargas‐Uricoechea et al., 2023 ). Such patients were repeatedly misdiagnosed with Hashimoto encephalopathy (HE) (Khoodoruth et al., 2020 ; Mattozzi et al., 2020 ; Mirabelli‐Badenier et al., 2014 ; Wu et al., 2023 ), which is steroid‐responsive encephalitis, which is confirmed by the presence of ATAbs as well as deranged thyroid functions (Schiess & Pardo, 2008 ). Most patients have elevated thyroid antibodies, which are necessary for diagnosis and include anti‐TPO (thyroid peroxidase) or antithyroglobulin.…”

Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Serum Anti-Thyroid Antibodies: A Case Report and Literature Review

“…Several studies showed that patients with autoimmune encephalitis have contemporary evidence of other autoimmune alterations and syndromes (eg, anti-nuclear Abs (ANA), thyroid peroxidase (TPO) Abs, Graves’ disease, neuromyelitis optica, type I diabetes) [ 17 – 20 ], according to the hypothesis that an autoimmune disorder increases the risk of an additional autoimmune disorder [ 21 ]. Over the past decade, several authors have pointed out the coexistence of anti-thyroid (Thy) Abs in non-paraneoplastic anti-NMDArE [ 21 ], but the clinical and pathogenetic significance of this association needs to be further explored. In the context of this ongoing debate, we present the present case report of an adolescent girl affected by a non-paraneoplastic anti-NMDArE associated with positive anti-TPO and anti-thyroglobulin (TG) circulating Abs; then, we discuss this finding together with other case reports selected through a brief review of the literature on the association between anti-NMDArE and serum anti-Thy Abs.…”