Hashimoto's encephalopathy presenting with micrographia as a typical feature of parkinsonism

We describe here a 63-year-old woman who presented with gait disturbance and micrographia. Laboratory tests demonstrated the presence of anti-thyroperoxidase (TPO) antibodies and vitamin B(12) deficiency accompanied by the presence of anti-parietal cell antibodies. Lymphocytosis with increased protein was detected in cerebral spinal fluid (CSF). Serum autoantibodies against the anti-NH(2) terminal of α-enolase (NAE), a specific diagnostic marker for Hashimoto's encephalopathy (HE), were also detected. Since underlying autoimmune conditions were suspected to be associated with Hashimoto's disease, steroid therapy was conducted, and the neurological symptoms improved a few days after the therapy was started. Attention should be given to the possibility that typical parkinsonism showing micrographia is caused by HE.