Hashimoto's encephalitis: Rare manifestation of hypothyroidism

Gutch, Manish; Bhattacharjee, Annesh; Kumar, Sudhir; Pushkar, Durgesh

doi:10.4103/ijabmr.ijabmr_256_16

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Patients with autoimmune encephalitis, especially those with SREAT, usually exhibit elevated titers of anti-TPO antibodies [ 21 , 22 ]. Moreover, SREAT has more recently been characterized in the literature as neurologic dysfunction exhibited in patients with high titers of anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies [ 23 ]. However, this does not mean that all patients with SREAT have additional thyroid hormone abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Encephalopathy Associated With Anti-thyroid Antibodies: A Case Report

Falb¹,

Costanzo²,

Avalos³

et al. 2022

Cureus

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Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto encephalopathy (HE), is a rare condition. HE is characterized by abnormal brain function associated with elevated titers of anti-thyroid peroxidase (anti-TPO) and/or anti-thyroglobulin (anti-Tg) antibodies. We present a case of a 19-year-old female with rapidly progressing psychosis with mutism, catalepsy, echopraxia, and catatonia that developed over the course of three months. She was found to have high-level anti-thyroid antibodies raising suspicion of subclinical autoimmune thyroiditis and positive antinuclear antibodies. Imaging of the brain revealed generalized cerebral atrophy abnormal for her age. The patient was aggressively treated with corticosteroids and immunomodulators and her symptoms were greatly improved. This case emphasizes the significance of thyroid antibody measurement in patients presenting with psychiatric symptoms to evaluate patients for autoimmune encephalitis, since treatment with steroids and other immunosuppressive agents may be warranted.

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Section: Discussionmentioning

confidence: 99%

Autoimmune Encephalopathy Associated With Anti-thyroid Antibodies: A Case Report

Falb¹,

Costanzo²,

Avalos³

et al. 2022

Cureus

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“…Hashimoto’s encephalopathy (HE), also known as steroid-responsive encephalopathy, is a rare but treatable autoimmune encephalopathy and is associated with autoimmune thyroid disease. Patients with HE have high titres of thyroid antibodies, especially TPOAb, and respond dramatically to corticosteroids 139 140. TPOAb screening should, therefore, be considered in patients with encephalopathy of unclear aetiology 139 141…”

Section: Introductionmentioning

confidence: 99%

Thyroid autoantibodies

2022

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Thyroid-stimulating hormone (TSH) receptor antibody (TSH-R-Ab or TRAb) testing plays a pivotal role in arriving at the aetiological diagnosis in patients with thyrotoxicosis. A positive test establishes the diagnosis of Graves’ disease (GD) while a negative result in conjunction with imaging studies supports other possible aetiologies. In patients with GD, TRAb levels at diagnosis and at the time of withdrawal of antithyroid drugs can identify patients who are unlikely to achieve remission and guide clinical management decisions. We provide an algorithm that incorporates TRAb in the decision-making process for the management of thyrotoxicosis. The utility of TRAb in predicting the risk of fetal and neonatal thyroid dysfunction is established and widely accepted in guidelines. TRAb may also help in the diagnosis of Graves’ orbitopathy, especially in euthyroid or hypothyroid patients and its role in guiding its management is evolving as a useful adjunct to the clinical parameters used in making therapeutic decisions.Anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TgAb) indicate thyroid autoimmunity. The most common use of TPOAb is to identify patients at a higher risk of progression to treatment-requiring hypothyroidism. They also aid the diagnosis of immune thyroiditis and Hashimoto’s encephalopathy. Thyroglobulin measurement is used to help guide differentiated thyroid cancer treatment. TgAb is used as an accompanying test with thyroglobulin measurement as its presence can interfere with the thyroglobulin assay. A negative TgAb result reduces the likelihood of, but does not exclude, interference with thyroglobulin assay.

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“…Hashimoto encephalopathy was first reported in 1966 and was associated with Hashimoto thyroiditis. 7 The neurological effects in such cases can be attributed to antibodymediated neuronal and glial injury, endothelial inflammation, or immune complex deposition. 10 Eventually, severe complications can occur, such as diffuse encephalomyelitis or cerebral vasculitis.…”

Section: Discussionmentioning

confidence: 99%

“…It is worth mentioning that these neurological manifestations respond well to steroids rather than to conventional treatments such as antidepressants, antipsychotics, or antiepileptic drugs, highlighting an autoimmune origin of the disorder. 7,8 Hashimoto encephalopathy, in rare cases, presents with catatonia, which may be associated with other neurological or psychiatric symptoms. Here we present a case of Hashimoto encephalopathy in a middleaged female who presented with catatonic symptoms along with other neurological symptoms.…”

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confidence: 99%

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Catatonia as the Presentation of Encephalopathy Associated With Autoimmune Thyroiditis: A Case Report and Literature Review

Ali,

Mohamed,

Al-Ghannami

et al. 2023

Journal of Psychiatric Practice

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Encephalopathy can be associated with autoimmune disorders such as autoimmune thyroiditis, and it can present with a wide range of neuropsychiatric manifestations. However, it rarely presents with catatonia. We present the case of a middle-aged female with Hashimoto’s thyroiditis presenting with catatonia. A literature review of previous similar cases highlighting significant points is also included. A 48-year-old female presented to the emergency department with catatonic symptoms that had worsened over the previous 5 days. A similar condition was reported to have occurred and resolved spontaneously 3 months earlier. On examination, the patient appeared uncooperative and unresponsive. She showed typical symptoms of catatonia, with a score of 21 points on the Bush-Francis Catatonia Rating Scale. Routine tests were within normal ranges except for an elevated level of C-reactive protein and an elevated erythrocyte sedimentation rate. Computed tomography, magnetic resonance imaging, and cerebrospinal fluid analysis were all normal. An electroencephalogram showed diffuse delta-theta range slowing with no epileptiform discharges. Lorazepam was initiated but did not control the catatonic symptoms. Re-evaluation revealed thyroid swelling and elevated levels of thyroperoxidase antibodies. IV methylprednisolone was therefore initiated and produced complete resolution of the catatonic symptoms in 4 hours. The patient was discharged and prescribed prednisone 1 mg/kg daily. At follow-up, the patient continued to show complete resolution of the catatonic symptoms. It is noteworthy that the patient developed hypothyroidism 6 months after this catatonic episode for which levothyroxine 50 mcg/d was prescribed. Encephalopathy associated with autoimmune thyroiditis can initially present with catatonic symptoms in euthyroid cases. The mainstay of treatment is steroids which result in complete resolution of the catatonic symptoms.

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Hashimoto's encephalitis: Rare manifestation of hypothyroidism

Cited by 5 publications

References 12 publications

Autoimmune Encephalopathy Associated With Anti-thyroid Antibodies: A Case Report

Autoimmune Encephalopathy Associated With Anti-thyroid Antibodies: A Case Report

Thyroid autoantibodies

Catatonia as the Presentation of Encephalopathy Associated With Autoimmune Thyroiditis: A Case Report and Literature Review

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