Hashimoto's Encephalopathy / SREAT Alliance
Symptoms
HE presents with a wide variety of symptoms.Patients may have mild clinical or subclinical hypothyroidism (elevated serum thyroid-stimulating hormone (TSH) and normal or low serum free thyroxine (T4) levels). However, normal thyroid function (TSH) is possible at the time of neurologic presentation. Hyperthyroidism (low TSH) is less commonly seen.
Clinical Presentation
People with Hashimoto's encephalopathy may experience:
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​Neurological Symptoms
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seizures (slowing is often seen in EEG)
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Myoclonus (sudden jerky muscle movements)
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Ataxia ( balance issues, trouble walking)
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Tremors
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Stroke-like episodes
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Changes in consciousness (confusion, coma)
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Headaches
Psychiatric Symptoms
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Depression
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Personality changes
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Cognitive impairment (memory, concentration, and thinking problems).
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Psychosis (hallucinations, delusions, and delusional behavior).
Other Symptoms:
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Fatigue
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Sleep disturbances
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Note: The information provided here is for educational purposes only and should not be considered medical advice. If you are experiencing any of these symptoms, it's crucial to seek medical attention for proper diagnosis and treatment.
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Payer J, Petrovic T, Lisy L, Langer P. Hashimoto encephalopathy: a rare intricate syndrome. Int J Endocrinol Metab. 2012 Spring;10(2):506-14. doi: 10.5812/ijem.4174. Epub 2012 Apr 20. PMID: 23843812; PMCID: PMC3693614.
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DIAGNOSIS & TREATMENTS
HASHIMOTO'S ENCEPHOLAPATHY
For a diagnosis of Hashimoto's Encephalopathy all 6 of the following criteria must be met:
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Encephalopathy with seizures, myoclonus, hallucinations, or stroke-like episodes
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Subclinical or mild overt thyroid disease (usually hypothyroidism)
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Brain MRI normal or with non-specific abnormalities
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Presence of serum thyroid (thyroid peroxidase, thyroglobulin) antibodies*
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Absence of well characterised neuronal antibodies in serum and CSF
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Reasonable exclusion of alternative causes
For a diagnosis of autoantibody (sero)- negative (probable autoimmune encephalitis), the following four criteria must be met:
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​Rapid progression
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Working memory deficits
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Short-term memory loss,
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Altered mental status or psychiatric symptoms
Criteria for autoantibody-negative but probable autoimmune encephalitis
Clinical Approach
HASHIMOTO'S ENCEPHOLAPATHY
A detailed clinical history
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Complete general examination
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Complete neurological examination
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Routine blood plus
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Antithyroid autoantibodies including Thyroid Peroxidase Antibody (TPO) or Thyroglobulin Antibody (TgAb) Thyroid and Stimulating Hormone Receptor Antibody (TRAb)
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inflammation markers such as C-reactive protein or erythrocyte sedimentation rate (ESR)
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Vitamin deficiency
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Heavy metals
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Oligoclonal bands (tests can be from a lumbar puncture as well)
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CSF analysis
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Opening pressure in the CSF
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Viral and bacterial encephalitis
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Meningitis
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Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid (ENC2 Mayo Clinic)
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Protein
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Glucose
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Oligoclonal bands
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Lymphocytic pleocytosis
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FDG-PET or SPECT
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Brain MRI including diffusion sequences (may show normal or nonspecific brain MRI abnormalities)
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EEG: (may show seizure-activity or slight slowing)
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Neuropsychological testing
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1.A clinical approach to diagnosis of autoimmune encephalitis Graus, Francesc et al.The Lancet Neurology, Volume 15, Issue 4, 391 - 404
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​Tardieu M, Deiva K. Rare inflammatory diseases of the white matter and mimics of multiple sclerosis and related disorders. Neuropediatrics. 2013 Dec;44(6):302-8. doi: 10.1055/s-0033-1358599. Epub 2013 Oct 28. PMID: 24166147.
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SERONEGATIVE AUTOIMMUNE ENCEPHALITIS
A detailed clinical history
​
Complete general examination
​
Complete neurological examination
​
Routine blood plus​
-
Inflammation markers such as C-reactive protein or erythrocyte sedimentation rate (ESR)
-
Vitamin deficiency
-
Heavy metals
-
Oligoclonal bands (tests can be from a lumbar puncture as well)
-
autoantibodies in serum
​
CSF analysis
-
Opening pressure in the CSF
-
Viral and bacterial encephalitis
-
Meningitis
-
Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid (ENC2 Mayo Clinic)
-
Protein
-
Glucose
-
Oligoclonal bands
-
Lymphocytic pleocytosis
​
FDG-PET or SPECT
​
Brain MRI including diffusion sequences (may show abnormalities suggestive of autoimmune encephalitis)
​
EEG: (may show seizure-activity or slight slowing)
​
Neuropsychological testing
​​​​​
​
1.A clinical approach to diagnosis of autoimmune encephalitis Graus, Francesc et al.The Lancet Neurology, Volume 15, Issue 4, 391 - 404
​
​Tardieu M, Deiva K. Rare inflammatory diseases of the white matter and mimics of multiple sclerosis and related disorders. Neuropediatrics. 2013 Dec;44(6):302-8. doi: 10.1055/s-0033-1358599. Epub 2013 Oct 28. PMID: 24166147.
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The following is a suggested clinical approach to diagnosis that is accessible to most physicians.The following content is for informational purposes only and should not be used to replace the advice of a qualified healthcare professional.