Differences

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

Link to this comparison view

Both sides previous revision Previous revision
Last revision Both sides next revision
cl:0-autoimmune-encephalitis:hashimotos [on July 6, 2020]
 cl:0-autoimmune-encephalitis:hashimotos [on July 18, 2023]
psychdb [Investigations]
Line 2: Line 2:
 {{INLINETOC}} {{INLINETOC}}
 ===== Primer ===== ===== 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 == == 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 == == 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 ===== ===== 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>​
 <WRAP group> <WRAP group>
 <WRAP half column> <WRAP half column>
Line 19: Line 20:
   - **Presence of serum thyroid antibodies** (thyroid peroxidase, thyroglobulin)   - **Presence of serum thyroid antibodies** (thyroid peroxidase, thyroglobulin)
   - **Absence of well characterized neuronal antibodies in serum and CSF**   - **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]])
 </​WRAP>​ </​WRAP>​
 <WRAP half column> <WRAP half column>
Line 36: Line 37:
 <WRAP group> <WRAP group>
 <WRAP half column> <WRAP half column>
-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.
 </​WRAP>​ </​WRAP>​
 <WRAP half column> <WRAP half column>
Line 44: Line 47:
 </​WRAP>​ </​WRAP>​
 </​WRAP>​ </​WRAP>​
- 
 ===== Treatment ===== ===== 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.]])] 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.]])]