Initial serum thyroid peroxidase antibodies and long-term outcomes in SREAT

Litmeier, Simon; Prüß, Harald; Witsch, Esther; Witsch, Jens

doi:10.1111/ane.12556

Cited by 30 publications

(22 citation statements)

References 20 publications

(21 reference statements)

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“…47 Among all patients, 12.5% have relapses, 12.5% exhibit no response, 3 and 60% are characterized as having a relapsing-remitting courses. 65 Anti-NMDAR encephalitis and other autoimmune encephalitis are considered to be a paraneoplastic syndrome. 25 Initial higher serum TPO-Ab titers associated with more satisfactory outcomes.…”

Section: Prognosismentioning

confidence: 99%

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Hashimoto encephalopathy: literature review

et al. 2016

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Hashimoto encephalopathy (HE) presents as an encephalopathy without central nervous system infection or tumor. HE is associated with autoimmune thyroiditis and is thus considered to be an autoimmune disorder. The prevalence of HE is low, but death and status epilepticus have been reported. HE manifests with a wide range of symptoms that include behavioral changes and confusion. Elevated thyroid antibodies are present in the majority of cases and are required for the diagnosis of HE. Normal brain MRI findings are found in the majority of patients diagnosed with HE. The most consistent CSF abnormality noted in HE patients is the presence of elevated protein. Most HE patients respond well to steroid therapy. Clinical improvements are also observed with IV immunoglobulin and plasmapheresis. In conclusion, it is now generally accepted that the diagnosis of HE must include encephalopathy characterized by cognitive impairment associated with psychiatric features, such as hallucinations, delusions, and paranoia. Autoimmune encephalitis and prion disease should be considered in the differential diagnosis due to the similarity of the clinical features of these conditions to those of HE.

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Section: Prognosismentioning

confidence: 99%

“…25 Initial higher serum TPO-Ab titers associated with more satisfactory outcomes. 65 Anti-NMDAR encephalitis and other autoimmune encephalitis are considered to be a paraneoplastic syndrome. Whether HE is also a paraneoplastic syndrome is not known.…”

Section: Prognosismentioning

confidence: 99%

Hashimoto encephalopathy: literature review

et al. 2016

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“…Isolated elevation of CSF proteins is present in up to 85% of patients, including our patient, suggesting an inflammatory process (1,5), which is further supported by brain biopsies showing lymphocytic perivascular infiltration (5,12). Anti-TPO antibodies have not been demonstrated to play a direct role in the pathogenesis of encephalopathy and are considered merely a marker of autoimmunity (1,2,5), although it is not clear whether higher titers may predict better prognosis as suggested in a recent small trial (13). Thyroid dysfunction itself is not thought to be involved in the pathogenesis of SREAT, as correction of thyroid status alone does not improve encephalopathy (1,5,9).…”

Section: Discussionmentioning

confidence: 99%

An Unusual Patient with Hashimoto Thyroiditis, Features of Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis, and Concurrent Minimal Change Renal Disease

Aleksić

Patel

et al. 2017

AACE Clinical Case Reports

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Objective:To present an unusual patient with Hashimoto thyroiditis, encephalopathy with features of steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), and acute kidney injury secondary to minimal change renal disease.Methods: We present clinical, laboratory, imaging, electroencephalography, and renal histopathologic findings, and review the relevant literature for evaluation and treatment of SREAT.Results: A 53-year-old woman with a history of hypothyroidism on levothyroxine was admitted for progressive altered mental status and bizarre behavior for 3 weeks. On exam she was lethargic with myoclonic jerks, hypertonia, and hyperreflexia. Laboratory analyses showed thyroidstimulating hormone of 0.057 μU/mL (normal, 0.27 to 4.0 μU/mL), free thyroxine of 1.5 ng/dL (normal, 0.7 to 1.5 ng/ dL), triiodothyronine of 0.7 ng/mL (normal, 0.6 to 1.6 ng/ dL), and elevated anti-thyroid peroxidase (>600 U/L) and antithyroglobulin (57.2 U/L) antibodies. The patient failed to improve with empiric antibiotics and anticonvulsants.She developed oliguric acute kidney injury with proteinuria requiring hemodialysis. Renal biopsy was consistent with minimal change disease and acute tubular necrosis. Further workup failed to identify infectious, structural, toxic, or neoplastic causes of the encephalopathy. SREAT was suspected and the patient was started on high-dose steroid therapy. Both the patient's mental status and renal function significantly improved with steroids and she was discharged home.Conclusion: We present, to our knowledge, the first case of Hashimoto thyroiditis associated with both encephalopathy with features of SREAT and minimal change renal disease. SREAT should be suspected in a patient with Hashimoto thyroiditis and unexplained encephalopathy that fails to respond to treatment. (AACE Clinical Case Rep. 2017;3:e299-e302) Abbreviations: anti-TPO = anti-thyroid peroxidase; CNS = central nervous system; CSF = cerebrospinal fluid; fT4 = free thyroxine; MRI = magnetic resonance imaging; SREAT = steroid-responsive encephalopathy associated with autoimmune thyroiditis; T3 = triiodothyronine; TSH = thyroid-stimulating hormone e300 SREAT Minimal Change Disease, AACE Clinical Case Rep. 2017;3(No. 4)

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“…Moreover, a couple of clinical improvements were shown to be accompanied by a decrease of serum TPO-Ab titers [ 1 , 2 ]. Higher serum TPO-Ab titers were correlated with better outcomes [ 5 ]. However, more long-term clinical observations considering the relationship between clinical outcome and antithyroid autoantibody titers are warranted.…”

Section: Introductionmentioning

confidence: 99%

Delirious Mania Associated with Autoimmune Gastrothyroidal Syndrome of a Mid-Life Female: The Role of Hashimoto Encephalopathy and a 3-Year Follow-Up including Serum Autoantibody Levels

Bonnet

Selle

Kuhlmann

2016

Case Reports in Psychiatry

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We report the case study of a 57-year-old Caucasian female with steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), commonly termed Hashimoto encephalopathy (HE). This presentation includes one of the longest lasting follow-up studies of HE considering the neuropsychiatric symptoms (here delirium, mania, and EEG-slowing) and their relation to serum autoantibody levels. Antithyroid-peroxidase autoantibodies, the hallmark of autoimmune thyroiditis, were found in the serum and also in the cerebrospinal fluid. Diagnostic analyses found no evidence of limbic encephalopathies characterized by serum antibodies against intracellular, synaptic, or further cell surface antigenic targets, neoplasm, and connective tissue or vasculitis diseases. A potential contribution of bipolar disorder and metabolic encephalopathies due to severe hypothyroidism, glucocorticoid treatment, accelerated thyroid hormone replacement therapy, or vitamin B deficiency is critically discussed. Another special feature of this case report is the linkage of HE to an autoimmune polyendocrine syndrome (type 3B) affecting the gastroduodenum in addition to the thyroid gland.

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Initial serum thyroid peroxidase antibodies and long-term outcomes in SREAT

Abstract: A correlation between TPO-Ab-titers and outcome has not been reported previously and challenges the notion of a mere bystander role of TPO-Abs in SREAT.

Cited by 30 publications

References 20 publications

Hashimoto encephalopathy: literature review

Hashimoto encephalopathy: literature review

An Unusual Patient with Hashimoto Thyroiditis, Features of Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis, and Concurrent Minimal Change Renal Disease

Delirious Mania Associated with Autoimmune Gastrothyroidal Syndrome of a Mid-Life Female: The Role of Hashimoto Encephalopathy and a 3-Year Follow-Up including Serum Autoantibody Levels

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