A case report of Hashimoto’s encephalitis in a young patient: a diagnostic challenge

Authors

  • Mogalapu Sai Samhitha Department of Internal Medicine, Madras Medical College, Chennai, India
  • Nithila Sivakumar Department of Internal Medicine, Madras Medical College, Chennai, India
  • Lakshiya Ramamoorthy Department of Internal Medicine, Madras Medical College, Chennai, India
  • Lakshmi Murugesan Department of Internal Medicine, Madras Medical College, Chennai, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20243396

Keywords:

Hashimoto’s encephalopathy, Encephalopathy, Autoimmune thyroiditis, Steroid responsive thyroiditis, Antithyroid antibodies, Hypothyroid

Abstract

Encephalopathy may arise from intrinsic neurological factors or systemic illnesses. The causes can be diverse, with many being reversible. Therefore, prompt identification of the underlying cause is essential for effective patient management. Hashimoto’s encephalopathy, also known as steroid-responsive encephalopathy with autoimmune thyroiditis (SREAT), is characterized by markedly elevated antithyroid peroxidase antibody levels, suggesting an autoimmune origin. The term SREAT reflects its remarkable responsiveness to corticosteroid therapy. Being readily reversible and its response to steroids, Hashimoto's encephalopathy should be taken into consideration when investigating cases of encephalopathies where no definite aetiology is found. Diagnosis involves ruling out other potential causes, including infections, dysglycemia, electrolyte imbalances, myxedema coma, thyroid storm, hypo- and hypercortisolism, among others. This report presents the case of a 25-year-old woman with a history of hypothyroidism who presented with altered consciousness. Following the exclusion of other potential causes, a diagnosis of Hashimoto’s encephalopathy was established, and the patient responded well to intravenous steroid treatment, showing marked clinical improvement. This highlights the importance of considering this differential in treating young hypothyroid patients presenting with altered mental status.

References

Chiarello P, Talarico V, Nicoletti A, et al. Hashimoto encephalopathy: A case report and a short revision of current literature. Acta Biomed. 2020;91:34-57.

Canevini MP, Sgarzi M, De Sarro G, et al. Antiepileptic drug treatment in children with epileptic encephalopathies: A national consensus survey of the Italian League Against Epilepsy (LICE). Front Neurol. 2019;10:440.

Chaudhuri J, Mukherjee A, Chakravarty A. Hashimoto's encephalopathy: Case series and literature review. Curr Neurol Neurosci Rep. 2023;23(4):167-75.

Chong JY, Rowland LP, Utiger RD. Hashimoto encephalopathy: Syndrome or myth? Neurology. 2003;60(2):368-74.

Olmez I, Moses H, Sriram S. Diagnostic and therapeutic aspects of Hashimoto's encephalopathy. J Neurol Sci. 2013;331(1-2):67-71.

Joaquim AF, Gomes JG. Neuropsychiatric manifestations in autoimmune thyroiditis: A case report and literature review. Psychiatry Rep. 2023;5(1):100198.

Li J, Li F. Hashimoto's encephalopathy and seizure disorders. Front Neurol. 2019;10:440.

Ramalho J, Castillo M. Hashimoto's encephalopathy. Radiol Case Rep. 2015;6(1):445.

Ahmed OM, El-Gareib AW, El-Bakry AM, Abd El-Tawab SM, Ahmed RG. Thyroid hormones states and brain development interactions. Int J Dev Neurosci. 2008;26(2):147-209.

Ochi H, Horiuchi I, Araki N. Proteomic analysis of human brain identifies alpha-enolase as a novel autoantigen in Hashimoto's encephalopathy. FEBS Lett. 2002;528(1-3):197-202.

Waliszewska-Prosół M, Bladowska J, Budrewicz S, et al. The evaluation of Hashimoto's thyroiditis with event-related potentials and magnetic resonance spectroscopy and its relation to cognitive function. Sci Rep. 2021;11(1):2480.

Ferracci F, Carnevale A. The neurological disorder associated with thyroid autoimmunity. J Neuropsychiatry Clin Neurosci. 2006;18(1):14-20.

Mocellin R, Walterfang M, Velakoulis D. Hashimoto's encephalopathy: Epidemiology, pathogenesis and management. CNS Drugs. 2007;21(10):799-811.

Nunez J, Celi FS, Ng L, Forrest D. Multigenic control of thyroid hormone functions in the nervous system. Mol Cell Endocrinol. 2008;287:11-42.

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Published

2024-10-30

How to Cite

Samhitha, M. S., Sivakumar, N., Ramamoorthy, L., & Murugesan, L. (2024). A case report of Hashimoto’s encephalitis in a young patient: a diagnostic challenge. International Journal of Research in Medical Sciences, 12(11), 4326–4329. https://doi.org/10.18203/2320-6012.ijrms20243396

Issue

Section

Case Reports