B – 113 Neuropsychological Profile of Pediatric Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis (SREAT): A Case Study

Abstract Objective Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a rare complex medical diagnosis with limited neuropsychological literature. Two case studies of adult females revealed challenges with executive functioning, processing speed, language, fine motor, and learning and memory. This case study aims to characterize the neuropsychological profile of a pediatric SREAT patient to inform clinical practice and contribute to the limited literature. To our knowledge, no neuropsychological profiles of pediatric SREAT patients have been published. Method The patient is a 16-year-old female with Hashimoto’s Thyroiditis who presented with refractory epilepsy with severe encephalopathy consistent with SREAT. Medical workup revealed elevated anti-thyroid peroxidase antibody levels and non-diagnostic MRI and CSF examinations. She was treated with immunotherapy (high-dose steroids, intravenous immunoglobulins, rituximab) with significant improvement in mental status and seizure frequency. At the time of testing, she remained on antiseizure medication and thyroid supplementation. Results Neuropsychological testing revealed intact intelligence, visual-motor integration, basic attention, and visual memory. Expressive and receptive language, fine motor, executive functioning, processing speed, memory, and academics (mathematics) emerged as weaknesses with Exceptionally Low performance on dominant-hand fine motor speed and dexterity, speeded oral decoding, and verbal memory (list-learning and paired words). Findings supported school reintegration with academic supports and accommodations addressing fatigue and cognitive overload. Conclusion This pediatric case demonstrated neurocognitive weaknesses paralleling adult SREAT profiles. The findings emphasize the need for targeted interventions across developmental domains during critical adolescent years. Further research with larger samples is essential to establish comprehensive understanding of pediatric SREAT’s neuropsychological impact and inform evidence-based treatment approaches.