Steroid-responsive encephalopathy associated with autoimmune thyroiditis

Area of Science:

• Neurology
• Endocrinology
• Immunology

Background:

• Hashimoto encephalopathy, also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is a rare neurological disorder.
• It is characterized by rapidly progressive dementia, stroke-like symptoms, psychosis, and positive antithyroid antibodies.

Purpose of the Study:

• To report a case of SREAT in an elderly patient presenting with acute neuropsychiatric symptoms.
• To highlight the importance of considering SREAT in geriatric populations with new-onset neurological and psychiatric disturbances.

Main Methods:

• A case report of a woman in her 80s with hypothyroidism presenting with hallucinations, memory loss, and paranoia.
• Diagnostic workup included antibody testing (thyroglobulin and thyroid peroxidase antibodies).
• Treatment involved high-dose intravenous methylprednisolone followed by an oral prednisone taper.

Main Results:

• The patient exhibited elevated antithyroid antibodies, indicative of SREAT.
• Initial high-dose steroid therapy resulted in marked improvement of her neuropsychiatric symptoms.
• A subsequent oral prednisone taper and follow-up care managed the condition effectively.

Conclusions:

• SREAT is a reversible cause of new-onset neuropsychiatric symptoms in the geriatric population.
• Early diagnosis and prompt treatment with systemic steroids are crucial for favorable outcomes.
• SREAT should be considered a "must-not-miss" diagnosis in elderly patients with unexplained neurological and psychiatric changes.