Hashimoto encephalopathy presenting as schizophrenia-like disorder

Area of Science:

• Neurology
• Psychiatry
• Immunology

Background:

• Hashimoto encephalopathy (HE) is an autoimmune disorder characterized by diverse neuropsychiatric symptoms.
• While often presenting with neurological signs, HE can manifest with psychiatric syndromes, mimicking other disorders.
• Steroid therapy is a recognized effective treatment for HE.

Observation:

• A 73-year-old woman with a history of autoimmune thyroiditis presented with a 3-year history of psychotic symptoms.
• Her symptoms were refractory to antipsychotic medications, prompting further investigation.
• Neurologic findings, including abnormal EEG and cognitive deficits, were noted upon admission.

Findings:

• The patient was diagnosed with Hashimoto encephalopathy.
• High-dose intravenous steroid therapy led to complete resolution of psychotic symptoms within days.
• This case underscores the potential for HE to present with purely psychiatric manifestations.

Implications:

• Hashimoto encephalopathy should be considered in the differential diagnosis of late-onset psychotic disorders, especially with abnormal EEG or autoimmune thyroiditis history.
• Early diagnosis and steroid treatment of HE can lead to rapid and complete symptom remission.
• Recognizing HE as a treatable cause of psychosis can prevent prolonged, ineffective psychiatric treatment.