Hashimoto's encephalopathy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Synonyms and keywords: steroid-responsive encephalopathy associated with autoimmune thyroiditis, SREAT

Overview

Hashimoto's Encephalopathy is a very rare condition associated with Hashimoto's thyroiditis. Hashimoto's Encephalopathy is a neuroendocrine disorder. Much like the antibodies in Hashimoto's thyroiditis attack the thyroid, in Hashimoto's encephalopathy, antibodies attack neurons of the brain.

Differentiating Hashimoto's encephalopathy from other disease

• Stroke - associated symptoms of paresis

• Alzheimer's disease- seen in old age and dementia is the most prominent symptom

Pathophysiology

A few theories are proposed for Hashimoto encephalopathy.

• Neuronal injury due to antibody mediated destruction.

• Immmune complex mediated vasculitis
• Toxic effect of increased thyroid stimulating hormone.

Diagnosis

Symptoms

• Headache

• Disorientation

• Psychosis

• Tremors

• Concentration and memory problems

Physical examination

• Jerks in the muscles

• Lack of coordination

• Partial paralysis

• Speech problems

Laboratory Findings

Blood and Biomarker Studies

• Blood TSH, T3, T4 levels

• Anti thyroid peroxidase levels

• CSF analysis - increased protein concentration, lymphocytic pleocytosis

Electroencephalogram

• Generalized slowing of activity

CT and MRI

• Non specific and show normal results

• In few patients atrophy may be seen

Treatment

Steroids or immunosuppressant treatment, this condition is now also referred to as "steroid-responsive" encephalopathy.