Hashimoto’s encephalopathy – an up-to-date overview

Joanna Szydełko, Michał Litwińczuk, Magdalena Szydełko


Introduction: Hashimoto’s encephalopathy (HE) is a rare, potentially life-threatening disease with a wide spectrum of clinical manifestations from slight symptoms to mainly neurological and psychiatric syndromes, which significantly debilitate the quality of life and make the diagnostic process complicated, especially in patients with no previous history of thyroid disorders. According to the recent data, it occurs in about 2.1 cases per 100 000 population with still increasing prevalence. Despite, over than fifty years have passed since the first case of HE was reported, its etiopathogenesis is not completely clarify and there is no universal diagnostic criteria.
Aim of the study: This article summarizes the current knowledge about pathophysiology, clinical manifestations, difficulties in differential diagnosis and therapeutic dilemmas in patients with HE.
Description of knowledge: HE is an autoimmune-mediated encephalopathy associated with Hashimoto’s disease and elevated titers of anti-thyroid antibodies, mainly anti-thyroid peroxidase antibody. The diagnostic process is usually multi-step due to various diseases mimicking HE, such as Creutzfeldt-Jacob disease, brain tumors, epilepsy, Alzheimer's disease, stroke, other forms of autoimmune encephalitis, schizophrenia, spontaneous cerebrospinal fluid leak or infectious encephalitis. The range of diagnostic procedures includes physical and mental examination, laboratory tests, brain imaging, EEG as well as cerebrospinal fluid analysis. However, the first line strategy based on steroids is effective, there are some cases in the literature that reveal this management as not fully sufficient, because only partial improvement was achieved or the steroid-dependence was observed. Among other therapeutic methods, plasmapheresis may be used additionally.
Conclusions: HE requires interdisciplinary approach and it constitutes a great challenge for clinicians of various specialties, such as endocrinologists, neurologists, and psychiatrists. The prompt implementation of adequate therapy usually provides the full recovery of the patients without any early or late complications.


Hashimoto’s encephalopathy; autoimmune encephalopathy; anti-thyroid antibodies

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Li J, Li F. Hashimoto's Encephalopathy and Seizure Disorders. Front Neurol. 2019;10:440. doi: 10.3389/fneur.2019.00440.

Tjong E, Gardner R, Peng YY. SREAT presenting as decades of intractable seizures and isolated delusional episodes with clinical, laboratory, and EEG confirmation of treatment response. SAGE Open Med Case Rep. 2019;7:2050313X19850051. doi: 10.1177/2050313X19850051.

Tomkins M, Cavalcoli F, Stanley E, O'Rourke K, Murphy S, Lynch T, et al. Autonomic alterations as a clinical manifestation of encephalopathy associated with autoimmune thyroid disease. Endocr J. 2018;65(8):869-875. doi: 10.1507/endocrj.EJ18-0035.

Pinedo-Torres I, Paz-Ibarra JL. Current knowledge on Hashimoto's encephalopathy: a literature review. Medwave. 2018;18(6):e7298. doi: 10.5867/medwave.2018.06.7298.

Sharma SR, Sharma N, Roy D. Hashimoto's encephalopathy in a pregnant female: A diagnosis in disguise. Ind Psychiatry J. 2018;27(2):302-304. doi: 10.4103/ipj.ipj_63_17.

Ercoli T, Defazio G, Muroni A. Status epilepticus in Hashimoto's encephalopathy. Seizure. 2019;70:1-5. doi: 10.1016/j.seizure.2019.06.020.

Ergul AB, Altuner Torun Y, Altug U, Mutlu FT, Celik SF, Guven AS. Congenital Hemophilia A Presenting With Hashimoto's Encephalopathy and Myocarditis: The First Reported Case. J Pediatr Hematol Oncol. 2018;40(7):e435-e438. doi: 10.1097/MPH.0000000000001045.

Oz Tuncer G, Teber S, Kutluk MG, Albayrak P, Deda G. Hashimoto's encephalopathy presenting as pseudobulbar palsy. Childs Nerv Syst. 2018;34(6):1251-1254. doi: 10.1007/s00381-018-3720-2.

Laycock K, Chaudhuri A, Fuller C, Khatami Z, Nkonge F, Stojanovic N. A novel assessment and treatment approach to patients with Hashimoto's encephalopathy. Endocrinol Diabetes Metab Case Rep. 2018;2018. pii: 17-0117. doi: 10.1530/EDM-17-0117.

Rukmangadachar LA, Dandapat S, Bit-Ivan EN, Peng YY. Hashimoto's encephalopathy - presenting with epilepsia partialis continua and a frontal lobe lesion. Clin Case Rep. 2017;6(1):136-142. doi: 10.1002/ccr3.1306.

Kaymakamzade B, Ertugrul Mut S, Eker A, Özkayalar H. Hashimoto's encephalopathy with partial response to steroid therapy: a case report. Hong Kong Med J. 2019;25(2):156-158. doi: 10.12809/hkmj177033.

Nagano M, Kobayashi K, Yamada-Otani M, Kuzuya A, Matsumoto R, Oita J, et al. Hashimoto's Encephalopathy Presenting with Smoldering Limbic Encephalitis. Intern Med. 2019;58(8):1167-1172. doi: 10.2169/internalmedicine.1289-18.

Chen KA, Brilot F, Dale RC, Lafferty AR, Andrews PI. Hashimoto's encephalopathy and anti-MOG antibody encephalitis: 50 years after Lord Brain's description. Eur J Paediatr Neurol. 2017;21(6):898-901. doi: 10.1016/j.ejpn.2017.06.002.

Hirose D, Hirao K, Kaneko Y, Fukasawa R, Sato T, Shimizu S, et al. Case of Hashimoto's encephalopathy showing atypical clinical course with magnetic resonance imaging abnormalities. Geriatr Gerontol Int. 2017;17(8):1235-1237. doi: 10.1111/ggi.13057.

Sipilä JOT, Rissanen E, Korpela J, Päivärinta M. Steroid-responsive encephalopathy with a peculiar CSF biomarker profile in an 89-year-old man. Oxf Med Case Reports. 2018;2018(10):omy073. doi: 10.1093/omcr/omy073.

Gutch M, Bhattacharjee A, Kumar S, Pushkar D. Hashimoto's Encephalitis: Rare Manifestation of Hypothyroidism. Int J Appl Basic Med Res. 2017;7(3):193-195. doi: 10.4103/ijabmr.IJABMR_256_16.

Cosso C, Ghio M, Cutolo M. Hashimoto's encephalopathy in a patient with septal panniculitis: a case report. Reumatismo. 2018;70(4):268-269. doi: 10.4081/reumatismo.2018.1090.

Varrasi C, Vecchio D, Magistrelli L, Strigaro G, Tassi L, Cantello R. Auditory seizures in autoimmune epilepsy: a case with anti-thyroid antibodies. Epileptic Disord. 2017;19(1):99-103. doi: 10.1684/epd.2017.0904.

Uwatoko H, Yabe I, Sato S, Abe M, Shirai S, Takahashi I, et al. Hashimoto's encephalopathy mimicking a brain tumor and its pathological findings: A case report. J Neurol Sci. 2018;394:141-143. doi: 10.1016/j.jns.2018.09.008.

Karthik MS, Nandhini K, Subashini V, Balakrishnan R. Hashimoto's Encephalopathy Presenting with Unusual Behavioural Disturbances in an Adolescent Girl. Case Rep Med. 2017;2017:3494310. doi: 10.1155/2017/3494310.

Al-Busaidi M, Burad J, Al-Belushi A, Gujjar A. Super Refractory Status Epilepticus in Hashimoto's Encephalopathy. Oman Med J. 2017;32(3):247-250. doi: 10.5001/omj.2017.46

Kong FX, Lu QH, Guo ZK. Multiple intracranial lesions as the unusual imaging features of Hashimoto's encephalopathy: A case report. Medicine (Baltimore). 2018;97(21):e10814. doi: 10.1097/MD.0000000000010814.

Cooper BL, Appel SE, Ammar HM. A young female with urinary retention - Hashimoto's Encephalopathy. Am J Emerg Med. 2017;35(6):943.e1-943.e2. doi: 10.1016/j.ajem.2017.01.054.

Amanat M, Thijs RD, Salehi M, Sander JW. Seizures as a clinical manifestation in somatic autoimmune disorders. Seizure. 2019;64:59-64. doi: 10.1016/j.seizure.2018.11.012.

Emeksiz S, Kutlu NO, Alaçakır N, Çaksen H. A case of steroid-resistance Hashimoto's

encephalopathy presenting with sensorimotor polyneuropathy. Turk J Pediatr. 2018;60(3):310-314. doi: 10.24953/turkjped.2018.03.012.

Alazzeh A, Jaroudi S, Gooch M, Peiris AN. Focal neurological presentation in Hashimoto's encephalopathy mimicking a vascular occlusion of the middle cerebral artery. BMJ Case Rep. 2017;2017. pii: bcr-2017-219933. doi: 10.1136/bcr-2017-219933.

Brown J, Sardar L. An autoimmune cause of confusion in a patient with a background of hypothyroidism. Endocrinol Diabetes Metab Case Rep. 2019;2019. pii: EDM190014. doi: 10.1530/EDM-19-0014.

Gauthier AC, Baehring JM. Hashimoto's encephalopathy mimicking Creutzfeldt-Jakob disease. J Clin Neurosci. 2017;35:72-73. doi: 10.1016/j.jocn.2016.09.019.

Sabbah-Talasazan L, Piryatinsky I. Neuropsychological impairment in Hashimoto's encephalopathy: A case report and literature review. Appl Neuropsychol Adult. 2018;25(6):572-580. doi: 10.1080/23279095.2017.1326048.

Endres D, Vry MS, Dykierek P, Riering AN, Lüngen E, Stich O, et al. Plasmapheresis Responsive Rapid Onset Dementia with Predominantly Frontal Dysfunction in the Context of Hashimoto's Encephalopathy. Front Psychiatry. 2017;8:212. doi: 10.3389/fpsyt.2017.00212.

Menon V, Subramanian K, Thamizh JS. Psychiatric Presentations Heralding Hashimoto's Encephalopathy: A Systematic Review and Analysis of Cases Reported in Literature. J Neurosci Rural Pract. 2017;8(2):261-267. doi: 10.4103/jnrp.jnrp_440_16.

Navin K, Kuppili PP, Bharadwaj B, Menon V. Is Depression with increased antithyroid autoantibodies a mere chance finding or Hashimoto's Encephalopathy? Asian J Psychiatr. 2018;32:112-113. doi: 10.1016/j.ajp.2017.11.034.

Tran MH, Mkhikian H, Sy M, Perez-Alvarez I, Demetriou M. Long-term plasma exchange as maintenance therapy for cerebellar-type Hashimoto's encephalopathy, a case report. Transfus Apher Sci. 2018;57(3):418-420. doi: 10.1016/j.transci.2018.05.027.

Simmons SC, Staley EM, Dorn DP, Nails AP, Marques MB, Williams LA 3rd, et al. Therapeutic plasma exchange For Hashimoto's encephalopathy. J Clin Apher. 2018;33(3):444-446. doi: 10.1002/jca.21597.

Jiang Y, Tian X, Gu Y, Li F, Wang X. Application of Plasma Exchange in Steroid-Responsive Encephalopathy. Front Immunol. 2019;10:324. doi: 10.3389/fimmu.2019.00324.

DOI: http://dx.doi.org/10.5281/zenodo.3460514


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