Differences

Last edited on July 18, 2023

This shows you the differences between two versions of the page.

--- cl:0-autoimmune-encephalitis:hashimotos [on August 26, 2019]
+++ cl:0-autoimmune-encephalitis:hashimotos [on July 18, 2023]
psychdb [Investigations]
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-====== Hashimoto's Encephalitis ======
+====== Hashimoto's Encephalitis (Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis [SREAT]) ======
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 ===== Primer =====
-**Hashimoto's Encephalopathy (HE)** (also known as Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis [SREAT]), is a rare, clinically heterogeneous neurological disorder associated with [[cl:thyroid-disorders:hashimotos|Hashimoto's disease]] and positive thyroid autoantibodies. It is increasingly recognized as an important and treatable cause of autoimmune encephalitis, though remains somewhat controversial as a diagnosis.
+**Hashimoto's Encephalopathy (HE)** (also known as Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis [SREAT]), is a rare, clinically heterogeneous neurological disorder associated with [[cl:thyroid-disorders:hashimotos|Hashimoto's disease]] and positive thyroid autoantibodies. It is is a form of [[cl:0-autoimmune-encephalitis:home|autoimmune encephalitis]]. It is increasingly recognized as an important and treatable cause of autoimmune encephalitis, though remains somewhat controversial as a diagnosis.
 == Epidemiology ==
-HE predominantly affects women in a wide age range, from 10 to 80 years of age.
+  * HE predominantly affects women in a wide age range, from 10 to 80 years of age.
 == Comorbidity ==
-Clinical or subclinical thyroid disease, usually hypothyroidism, occurs in over half of the cases.
+  * Clinical or subclinical thyroid disease, usually [[cl:thyroid-disorders:hypothyroidism|hypothyroidism]], occurs in over half of the cases.
 ===== Diagnostic Criteria =====
+<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also main article: **[[cl:0-autoimmune-encephalitis:home]]**</alert>
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   - **Presence of serum thyroid antibodies** (thyroid peroxidase, thyroglobulin)
   - **Absence of well characterized neuronal antibodies in serum and CSF**
-  - **Reasonable exclusion of alternative causes** ([[cl:0-autoimmune-encephalitis#differential-diagnosis|see Differential Diagnosis]])
+  - **Reasonable exclusion of alternative causes** ([[cl:0-autoimmune-encephalitis:home#differential-diagnosis|see Differential Diagnosis]])
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 The clinical presentation of HE can include seizures, myoclonus, hallucinations, and stroke-like episodes with normal or non-specific CSF and brain MRI abnormalities.
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+<callout type="question" title="Controversial Diagnosis" icon="true">
+Hashimoto’s encephalopathy should be diagnosed only when a thorough clinical assessment has been performed, including comprehensive testing for well characterized neuronal antibodies, and ruling out other potential causes of encephalopathy or encephalitis. In essence, it should be a diagnosis of exclusion.</callout>
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-anti-TPO, anti-thyroglobulin, and anti-dsDNA can be elevated in HE.
+  * anti-TPO (thyroid peroxidase antibody), anti-thyroglobulin, and anti-dsDNA can be elevated in HE
+    * Thyroid peroxidase antibody is elevated in over 90% of cases of Hashimoto’s thyroiditis.
+    * Although the the test has a false positive rate of up to 20%, a positive result may indicate SREAT, and should prompt a thorough search for neurological symptoms that might support a diagnosis of encephalopathy.
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-<callout type="warning" title="Antibodies Are Non-Specific!" icon="true">
+<callout type="warning" title="Thyroid Antibodies Are Non-Specific!" icon="true">
 Thyroid antibodies are not specific for Hashimoto’s encephalopathy. They can be present in up to 13% of healthy individuals, and up to 27% in white women older than 60 years. It can also be present in other autoimmune encephalitis disorders.
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 ===== Treatment =====
 Patients with a non-specific encephalopathy with subclinical or overt thyroid disease, anti-thyroid antibodies, and no other explanation for the symptoms should be considered for a trial of steroids. Most patients treated with corticosteroids with or without levothyroxine will have clinical improvement.[([[https://www.ncbi.nlm.nih.gov/pubmed/12580699/|Chong, J. Y., Rowland, L. P., & Utiger, R. D. (2003). Hashimoto encephalopathy: syndrome or myth? Archives of neurology, 2, 164–171.]])]
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   * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2018852/|Gómez-Bernal, G. J., Reboreda, A., Romero, F., Bernal, M. M., & Gómez, F. (2007). A case of Hashimoto's encephalopathy manifesting as psychosis. Primary care companion to the Journal of clinical psychiatry, 9(4), 318.]]
   * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693614/|Payer, J., Petrovic, T., Lisy, L., & Langer, P. (2012). Hashimoto encephalopathy: a rare intricate syndrome. International Journal of Endocrinology and Metabolism, 10(2), 506.]]
+  * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714092/|Maroz, N., Bernhardt, N., & Chow, R. D. (2012). Autoimmune encephalopathy associated with thyroid autoantibodies as the cause of reversible cognitive impairment. Journal of community hospital internal medicine perspectives, 2(1), 11453.]]
+  * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209691/|Anand, K. S., Garg, J., Verma, R., & Chakraborty, A. (2014). Hashimoto's encephalitis: Unusual cause of reversible dementia. Journal of family medicine and primary care, 3(3), 284.]]
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