Hashimoto's Encephalopathy Presenting with Chorea

Area of Science:

• Neurology
• Immunology
• Endocrinology

Background:

• Hashimoto's encephalopathy (HE) is a rare neurological condition characterized by steroid-responsive neuropsychiatric symptoms.
• It is often associated with elevated antithyroid antibodies, irrespective of thyroid function.
• Differential diagnosis involves excluding various causes of encephalopathy, including vascular, infectious, metabolic, autoimmune, paraneoplastic, and toxic etiologies.

Observation:

• A 78-year-old female presented with acute behavioral abnormalities and choreiform movements of the extremities.
• Extensive investigations ruled out other potential causes of encephalopathy.
• High titers of anti-thyroid peroxidase (anti-TPO) antibodies were detected.

Findings:

• The patient was diagnosed with Hashimoto's encephalopathy based on clinical presentation and serological findings.
• Treatment with high-dose corticosteroids resulted in a rapid and significant improvement in her neurological and behavioral symptoms.
• The choreiform movement, a key presenting symptom, resolved following steroid administration.

Implications:

• This case highlights the importance of considering HE in the differential diagnosis of unexplained encephalopathy, particularly in the presence of high antithyroid antibodies.
• Early recognition and prompt immunosuppressive therapy, such as high-dose steroids, can lead to favorable outcomes.
• Further research into the pathogenesis of HE and its specific antibody targets may refine diagnostic and therapeutic strategies.