Endocrine Abstracts

Hashimoto’s encephalopathy (HE) is a very rare neuropsychiatric condition associated with autoimmune thyroid disorders which shows a remarkable response to steroid therapy and hence is also called steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT).

We report a case of 44 year old lady presenting twice with psycho-affective symptoms but not receiving the diagnosis on first presentation. She initially presented with 3 weeks history of low moods, lethargy, apathy and increased somnolence. All the initial investigations including blood cultures, virology screen, CT brain and CSF analysis were reported as normal. She had a past medical history of well controlled hypothyroidism and epilepsy but no psychiatric problems. She was labelled as being depressed and was discharged after referral to psychiatry team.

Two weeks later she re-presented with worsening symptoms of low mood, confusion and paranoid behaviour. Multiple Blood cultures, drug toxicology screen and virology screen were normal. CSF analysis (Glucose=4.3 mmol/l; Protein=0.26 g/l; no xanthochromia) were all reported as normal. Neurology investigations for rare encephalopathies (anti VGCC antibodies, anti VGKC antibodies, anti NMDA antibodies) were also normal. It was only after excluding all the metabolic and infective encephalopathies, the final diagnosis of Hashimoto’s encephalopathy was reached. Her anti-TPO antibodies were raised. The MRI brain and EEG findings also supported the diagnosis. She was started on high dose of steroids. There was immediate improvement in neuropsychiatric symptoms but she still continues to have emotional lability.

Hashimoto’s encephalopathy (HE) is a diagnosis of exclusion which is often missed but if considered after ruling out other causes in such presentations, it shows dramatic response to steroids. This case illustrates that HE can present with psychiatric symptoms in patients with long standing well- controlled hypothyroidism.