HE is a diagnosis of "exclusion."

Alternative diagnosis

must be ruled out (examples):

  • Toxic, infectious or metabolic causes.

  • Nutrient deficiencies (especially B vitamins- potentially masked by MTHFR gene variants)

  • Other autoimmune encephalitis with known antibodies (see here)

  • Traditional (non-autoimmune) epilepsy

  • Complications of thyroid disease

  • Migraine variants

  • Parathyroid tumors

  • Adrenal insufficiency



Testing blood and spinal fluid for:

  • Antithyroid autoantibodies including Thyroid Peroxidase Antibody (TPO) or Thyroglobulin Antibody (TgAb)


  • Thyroid and Stimulating Hormone Receptor Antibody (TRAb)


  • Check for the presence of other antibodies associated with cognitive or psychiatric symptoms such as Anti-NMDA Receptor (NMDAR) encephalitis or other AE's. (See here)


  • Vital lab tests to rule out life-threatening or debilitating conditions such as viral or bacterial encephalitis, meningitis or Creutzfedt-Jakov disease. 


  • Check for presence of inflammation markers such as C-reactive protein or erythrocyte sedimentation rate (ESR)


  • Protein levels


  • Glucose levels


  • Oligoclonal bands


  • Opening pressure in the CSF


  • Checked for significant vitamin deficiency


  • Presence of heavy metals

PET or SPECT scans to look for hypoperfusion or hypometabolism

MRI to check for evidence of physical damage to brain

EEG to look for evidence of seizure-activity or of noticeable slight slowing

Neuropsychological testing to objectively identify specific areas and degrees of impairment.

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This website is not a substitute for professional advice, and the content here is not intended for use in diagnosing, curing, or preventing disease. The site does not employ and is not overseen by medical professionals. Articles and studies listed here are intended solely for personal use and reference.  Although you will find a great deal of information about HE/SREAT on this website, HESA cannot provide medical advice. If you have HE/SREAT, or think you may have it, consult a qualified neurologist,

preferably one with experience addressing immune-mediated illness. 

© 2019 Hashimoto's Encephalopathy SREAT Alliance,  an Illinois not-for-profit corporation