Current knowledge on Hashimoto's encephalopathy: a literature review

Homology between TSH-R Tg TPO and Hashimoto rsquo s encephalopathy autoantigens

“…We think that our work represents a significant advance in the pathogenesis of SREAT, upon keeping in mind the possible mechanism of SREAT as deriving by thyroid Ab that circulate in the CSF, because either synthesized intrathecally (11) or, more likely, systemically derived and crossing the damaged blood-brain barrier, and that may react with intracranial antigens (32)(33)(34)(35). The homologies that we report here for the first time validate the hypothesis that we had formulated, support the mechanism of autoantigens expressed in CNS and thyroid (alpha-enolase, DDAHI and AKRIAI) that share homology with the classic thyroid autoantigens (Tg, TPO and TSH-R).…”

Lingering Effects: Hashimoto’s Encephalopathy

“…Current knowledge of pathogenesis has been reviewed elsewhere [ 3 ]. Because of its rare nature, highly variable presentation [ 1 ], and lack of formal diagnostic criteria, HE is frequently absent from the differential, making it difficult to diagnose, if not mistaken for other diagnoses [ 4 ]. Here, our patient was not diagnosed until the second admission, delaying treatment.…”

“…Hashimoto's encephalopathy (HE) is a rare immune-mediated disease that remains poorly understood. Diagnosis is characterized by neuropsychiatric symptoms with alternate causes of encephalopathy excluded, elevated anti-thyroid antibody titers, and rapid improvement following immunomodulatory therapy [ 1 ]. Despite the name, HE is not exclusively associated with the anti-thyroid peroxidase (TPO) antibodies of Hashimoto's thyroiditis.…”

“…Despite the name, HE is not exclusively associated with the anti-thyroid peroxidase (TPO) antibodies of Hashimoto's thyroiditis. Rather, HE is associated with any anti-thyroid antibody, including anti-thyroglobulin and anti-TSH receptors [ 1 ]. Coupled with its rapid response to corticotherapy, it is also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT).…”

Inpatient Management of Encephalopathy

“…Higher cut-off levels (more than five times the normal value) have been suggested to differentiate the disease from the false-positive low titer anti-thyroid antibodies in the healthy population. But, patients with a smaller elevation in antibody titers may still respond to steroid challenges in clinical practice [ 18 ].…”