Hashimoto Encephalopathy: A Rare Intricate Syndrome


Juraj Payer 1 , * , Tomas Petrovic 1 , Lubomir Lisy 2 , Pavel Langer 3

1 Clinic of Internal Medicine, Faculty of Medicine, Comenius University, Faculty Hospital Ruzinov, [email protected], Slovakia

2 Clinic of Neurology, Slovak Medical University, Slovakia

3 Institute of Experimental Endocrinology, Slovak Acadeamy of Sciences, Slovakia

How to Cite: Payer J, Petrovic T, Lisy L, Langer P. Hashimoto Encephalopathy: A Rare Intricate Syndrome, Int J Endocrinol Metab. Online ahead of Print ; 10(2):506-514. doi: 10.5812/ijem.4174.


International Journal of Endocrinology and Metabolism: 10 (2); 506-514
Published Online: December 1, 2012
Article Type: Case Report
Received: January 17, 2012
Accepted: February 29, 2012


Recently, several patients have been reported with various signs of encephalopathy and high thyroid antibody levels together with good responsiveness to glucocorticoid therapy. Despite the various clinical presentations, these cases have been termed Hashimoto encephalopathy (HE). Although all of the pathogenic components have not yet been clearly elucidated, it is believed that brain vasculitis and autoimmunity directed against common brain-thyroid antigens represent the most likely etiologic pathway. The most common clinical signs include unexplained or epilepsy-like seizures resistant to anti-convulsive treatment, confusion, headaches, hallucinations, stroke-like episodes, coma, impairment of cognitive function, behavioral and mood disturbance, focal neurological deficits, disturbance of consciousness, ataxia, and presenile dementia, together with the presence of high thyroid antibody levels, especially against thyroperoxidase (TPOab). In most cases, the thyroid function is normal or decreased; the thyroid function is rarely increased. The examination of the cerebrospinal fluid, EEG, MRI, SPECT, and neuropsychological examinations are primarily used as diagnostic tools. Most cases showed neural symptoms for months before the acute onset; in some cases, a dramatic acute onset was described. Once the diagnosis is made, corticosteroid treatment usually provides a dramatic recovery. The authors also present a short review of literary cases reported in last decade.

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