Managing Hashimoto’s Encephalopathy: A Case Report

Hashimoto's encephalopathy (HE), also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is a rare condition associated with thyroid autoimmunity. Characterized by cognitive decline, seizures, and neuropsychiatric symptoms, HE remains poorly understood and poses diagnostic challenges due to its variable criteria presentations and overlap with other conditions. Diagnosis typically involves clinical criteria, emphasizing encephalopathy in conjunction with positive thyroid antibodies, exclusion of alternative causes, and responsiveness to corticosteroid treatment. We present the case of a 76-year-old male patient admitted with acute gait disturbance and disorientation, later developing seizures and respiratory failure. Initial imaging demonstrated diffuse cortical atrophy, nonspecific white matter ischemic changes, and a right frontal meningioma. While infections and metabolic causes were ruled out, significantly elevated anti-thyroid peroxidase (ATPO) antibodies suggested HE. Corticosteroid therapy was administered with methylprednisolone pulse treatment (1 g/day for three days), leading to substantial neurological improvement and stabilization. Despite some residual ataxic symptoms, the patient's overall functional and cognitive status showed significant recovery. This case emphasizes the importance of considering HE in patients with unexplained encephalopathy and positive thyroid antibodies. Early intervention with corticosteroids can be vital in preventing lasting neurological damage. Continued research into HE is essential to refine diagnostic criteria, enhance differential diagnosis, and establish evidence-based treatment protocols that optimize patient outcomes.