Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT): A case report

Abstract

Background: Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto’s encephalopathy, is a disorder characterized by an encephalopathy associated with anti-thyroid antibodies in the absence of alternative causes. It has a wide range of clinical, laboratory and radiological features. Objective: Cases of steroid-responsive encephalopathy associated with autoimmune thyroiditis are difficult to diagnose and requires a high index of suspicion, as this will determine the early timing of management and disease outcome. Patient and Methods: Here we present a case report of twenty-year-old woman presenting with neurological and psychological symptoms. She was found to have high anti-thyroid peroxidase antibodies (Anti-TPO) with normal thyroid function and negative screening for other etiologies of encephalopathy. Based on her presentation, she was diagnosed with steroid-responsive encephalopathy associated with autoimmune thyroiditis. Results: Patient was started on high dose steroids upon which she responded partially. Then she required the addition of immunotherapy in the form of Rituximab to improve her symptoms. Conclusion: After exclusion of other causes of encephalopathy, the presence of thyroid antibodies prompts the suspicion of SREAT and therefore the early initiation of steroids to improve patients’ outcome.