Hashimoto's encephalopathy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Overview
Hashimoto's Encephalopathy is a very rare condition associated with Hashimoto's Thyroiditis. Hashimoto's Encephalopathy is a neuroendocrine disorder. Much like the antibodies in Hashimoto's Thyroiditis attack the thyroid, in Hashimoto's Encephalopathy, antibodies attack neurons in the brain.
Pathophysiology
A few theories are proposed for Hashimoto encephalopathy.
- Neuronal injury due to antibody mediated destruction.
- Immmune complex mediated vasculitis
- Toxic effect of increased thyroid stimulating hormone.
Diagnosis
Symptoms
- Concentration and memory problems
Physical examination
- Jerks in the muscles
- Lack of coordination
- Partial paralysis
- Speech problems
Lab tests
- Blood TSH, T3, T4 levels
- Anti thyroid peroxidase levels
- CSF analysis - increased protein concentration, lymphocytic pleocytosis
Electroencephalogram
- Generalized slowing of acitivity
CT and MRI
- Non specific and show normal results
- In few patients atrophy may be seen
Differential diagnosis
Treatment
Steroids or immunosuppressant treatment, this condition is now also referred to as "steroid-responsive" encephalopathy.