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cl:0-autoimmune-encephalitis:hashimotos [on August 26, 2019]
cl:0-autoimmune-encephalitis:hashimotos [on July 18, 2023] (current)
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 ===== ===== 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>​
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   - **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]])
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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. 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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 +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 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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- 
 ===== 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.]])]
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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/​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/​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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