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Şorodoc V, Constantin M, Asaftei A, Lionte C, Ceasovschih A, Sîrbu O, Haliga RE, Şorodoc L. The use of intravenous immunoglobulin in the treatment of Hashimoto's encephalopathy: case based review. Front Neurol 2023; 14:1243787. [PMID: 37745658 PMCID: PMC10513043 DOI: 10.3389/fneur.2023.1243787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Hashimoto's encephalopathy (HE) is a controversial immunological neuropsychiatric disease, with a poorly understood pathogenesis. It is characterized by symptoms of acute or subacute encephalopathy which usually occur in the presence of elevated levels of antithyroid antibodies. Even though it is also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), some cases appear to be steroid-resistant. This review examined whether treatment of Hashimoto's encephalopathy with intravenous immunoglobulin (IVIG) is associated with better clinical outcomes than the standard therapy. Additionally, we presented a case of a 59-year-old man who presented with severe neurological manifestations and was successfully treated with intravenous immunoglobulin. Methods The online databases PubMed and EMBASE were searched. Results A total of 1,365 articles were identified. After the deletion of 112 duplicates, 1,253 studies were screened by evaluating the title and abstract, focusing on Hashimoto's encephalopathy cases where IVIG were used. 846 studies were excluded because they were not relevant to the topic or included pediatric population. Therefore, 407 full-text articles were assessed for eligibility. The final analysis included 14 eligible articles after 393 were excluded (irrelevant texts, not written in English, full-text not available). In the majority of the selected case-reports, IVIG was associated with a good outcome, sometimes even with dramatic improvements in patient's status. Conclusion In last years, intravenous immunoglobulin therapy proved its utility in Hashimoto's encephalopathy's treatment, being a well tolerated therapy associated with remarkable improvement in patient's status. Further research is still needed in order to define the optimal treatment protocol for Hashimoto's encephalopathy and to establish if intravenous immunoglobulin can also be used as a first-line therapy, alone or in combination with steroids.
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Affiliation(s)
- Victoriţa Şorodoc
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mihai Constantin
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Andreea Asaftei
- 2nd Rheumatology Department, Clinical Rehabilitation Hospital, Iasi, Romania
| | - Cătălina Lionte
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Alexandr Ceasovschih
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Oana Sîrbu
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Raluca Ecaterina Haliga
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Laurenţiu Şorodoc
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
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Relationship between thyroid hormones and central nervous system metabolism in physiological and pathological conditions. Pharmacol Rep 2022; 74:847-858. [PMID: 35771431 DOI: 10.1007/s43440-022-00377-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022]
Abstract
Thyroid hormones (THs) play an important role in the regulation of energy metabolism. They also take part in processes associated with the central nervous system (CNS), including survival and differentiation of neurons and energy expenditure. It has been reported that a correlation exists between the functioning of the thyroid gland and the symptoms of CNS such as cognitive impairment, depression, and dementia. Literature data also indicate the influence of THs on the pathogenesis of CNS diseases, such as Alzheimer's disease, epilepsy, depression, and Parkinson's disease. This review describes the relationship between THs and metabolism in the CNS, the effect of THs on the pathological conditions of the CNS, and novel options for treating these conditions with TH derivatives.
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Amamou B, Ben Saida I, Ben Haouala A, Mhalla A, Zaafrane F, Gaha L. Hashimoto’s Encephalopathy Revealed by Hypochondriacal Delusion: A Case Report Involving a Male Patient. Am J Mens Health 2020; 14:1557988320955080. [PMID: 32938289 PMCID: PMC7503015 DOI: 10.1177/1557988320955080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hashimoto’s encephalopathy (HE) is a rare autoimmune disorder. It associates encephalopathy with autoimmune thyroiditis, presenting abnormal elevations of thyroid antibodies. It is more common in females. It can present with various symptoms, including seizures, myoclonus, psychosis, hallucinations, and mood disturbances. Hypochondriacal delusion is an unusual clinical presentation of this disorder. The authors report a case of HE in a male patient whose clinical presentation was dominated by hypochondriacal delusion. The absence of response to antipsychotics, high serum antithyroid peroxidase antibodiesof about 199 UI/ml, the normality of magnetic resonance imaging, and improvement with corticosteroids confirmed the diagnosis. This neuroendocrine disorder is often misdiagnosed and it represents a diagnostic challenge for clinicians. It should be considered in patients presenting a refractory or an atypical neuropsychiatric disorder and having a family history of autoimmune disease.
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Affiliation(s)
- Badii Amamou
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
| | - Imen Ben Saida
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Amjed Ben Haouala
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
| | - Ahmed Mhalla
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
| | - Ferid Zaafrane
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
| | - Lotfi Gaha
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Faculty of Medecine of Monastir, University of Monastir, Monastir, Tunisia
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Ishihara K, Naitoh Y, Fukui Y, Asahi T. [A case of Hashimoto's encephalopathy showing improvement in higher brain functions after a low-dose steroid therapy]. Rinsho Shinkeigaku 2019; 59:570-574. [PMID: 31474641 DOI: 10.5692/clinicalneurol.cn-001301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Here, we describe a case involving an 83-year-old woman who was admitted to our hospital for rehabilitation after pseudogout treatment. She had temporal and spatial disorientation. Neuropsychological assessment revealed frontal dysfunction, memory impairment, and executive dysfunction, in addition to general cognitive impairment. Subsequent laboratory examination revealed euthyroid status and elevated titers of anti-thyroid autoantibodies. MRI of the brain revealed no abnormal finding. However, electroencephalography revealed diffuse slowness. We diagnosed Hashimoto's encephalopathy on the basis of the clinical symptoms and laboratory findings. Administration of low-dose prednisolone (5 mg/day) alleviated general cognitive impairment and the laboratory findings; however, memory impairment and construction disorder remained. Previous studies suggest that the characteristics and clinical course of higher brain-function disorder associated with Hashimoto's encephalopathy vary on an individual basis, wherein some patients may respond well to low-dose steroid therapy. Here, we also encountered such a case, that showed good response to a low-dose steroid therapy.
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Affiliation(s)
- Kenji Ishihara
- Department of Neurology, Asahi Hospital of Neurology and Rehabilitation
| | - Yurino Naitoh
- Department of Rehabilitation, Asahi Hospital of Neurology and Rehabilitation
| | - Yasuhito Fukui
- Department of Clinical Psychology, Asahi Hospital of Neurology and Rehabilitation
| | - Toshiomi Asahi
- Department of Neurology, Asahi Hospital of Neurology and Rehabilitation
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Sabbah-Talasazan L, Piryatinsky I. Neuropsychological impairment in Hashimoto's encephalopathy: A case report and literature review. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 25:572-580. [PMID: 28548544 DOI: 10.1080/23279095.2017.1326048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hashimoto's encephalopathy (HE) is a rare neurological syndrome characterized by the presence of positive serum antithyroid antibodies, altered mental status, and clinical response to glucocorticoid therapy. Although HE has been documented in the literature from a medical standpoint, reports on the neuropsychological presentation of this syndrome are scarce. This article presents a literature review of cognitive deficits reported in HE cases. In addition, we describe the case of a 76-year-old Russian speaking woman diagnosed with HE in May 2012. MRIs from her disease course and treatment are presented. Posttreatment neuropsychological testing revealed intact attention and construction and impairment in working memory, processing speed, learning, executive functioning, language, and bilateral fine motor dexterity, all of which impacted her functional abilities. Her profile was inconsistent with the typical dementia process. This case demonstrates the utility of neuropsychological assessment for understanding cognitive and functional consequences of HE. The issue of differential diagnosis with dementia is also discussed.
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Affiliation(s)
| | - Irene Piryatinsky
- b Department of Psychiatry , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
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Ramcharan K, Hosein N, Teelucksingh JD, Rampersad F, Teelucksingh S. Prominent Bilateral Hand Tremor in Hashimoto's Encephalopathy: A Video Demonstration. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:419. [PMID: 27790384 PMCID: PMC5075043 DOI: 10.7916/d8pv6kjb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/06/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hashimoto's encephalopathy often presents with neuropsychiatric manifestations including seizures and movement disorders. CASE REPORT We describe a patient who presented with bilateral hand tremor and mild cognitive defects that fulfilled the criteria for a diagnosis of Hashimoto's encephalopathy. There was a rapid response to glucocorticoid therapy with relapse following treatment withdrawal. DISCUSSION Recently published clinical criteria for the diagnosis of Hashimoto's encephalopathy include seizures, myoclonus, hallucinations, or stroke-like episodes but do not include tremor. Our case had mild cognitive dysfunction and a coarse tremor as the predominant clinical features, which probably represent mild disease.
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Affiliation(s)
- Kanterpersad Ramcharan
- Neurology Unit, San Fernando Teaching Hospital, University of the West Indies, San Fernando, Trinidad and Tobago
| | - Nadeem Hosein
- Neurology Unit, San Fernando Teaching Hospital, University of the West Indies, San Fernando, Trinidad and Tobago
| | - Joel David Teelucksingh
- Endocrinology Unit, San Fernando Teaching Hospital, University of the West Indies, San Fernando, Trinidad and Tobago
| | - Fidel Rampersad
- Interventional Radiology, University of the West Indies, St Augustine, Trinidad and Tobago; Department of Clinical Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
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Rapidly progressive dementia with false-positive PCR Tropheryma whipplei in CSF. A case of Hashimoto's encephalopathy. J Neurol Sci 2015; 355:213-5. [DOI: 10.1016/j.jns.2015.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/09/2015] [Accepted: 05/25/2015] [Indexed: 11/23/2022]
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Kang WH, Na JY, Kim MK, Yoo BG. Hashimoto's Encephalopathy Presenting with Acute Cognitive Dysfunction and Convulsion. J Epilepsy Res 2014; 3:70-3. [PMID: 24649476 PMCID: PMC3952252 DOI: 10.14581/jer.13013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 12/26/2013] [Indexed: 11/08/2022] Open
Abstract
Hashimoto’s encephalopathy is an immune-mediated disorder characterized by acute or subacute encephalopathy related to increased anti-thyroid antibodies. Clinical manifestations of Hashimoto’s encephalopathy may include stroke-like episodes, altered consciousness, psychosis, myoclonus, abnormal movements, seizures, and cognitive dysfunction. Acute cognitive dysfunction with convulsion as initial clinical manifestations of Hashimoto’s encephalopathy is very rare. We report a 65-year-old man who developed acute onset of cognitive decline and convulsion due to Hashimoto’s encephalopathy.
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Affiliation(s)
- Woo-Hyuk Kang
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| | - Ju-Young Na
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| | - Meyung-Kug Kim
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| | - Bong-Goo Yoo
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
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Adult-onset temporal lobe epilepsy, cognitive decline, multi-antiepileptic drug hypersensitivity, and Hashimoto's encephalopathy: Two case studies. EPILEPSY & BEHAVIOR CASE REPORTS 2013; 1:132-5. [PMID: 25667846 PMCID: PMC4150645 DOI: 10.1016/j.ebcr.2013.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 11/22/2022]
Abstract
Hashimoto's encephalopathy is defined by the coexistence of encephalopathy and antithyroid antibodies. We report two cases of adult-onset temporal lobe epilepsy with subacute cognitive decline, high titers of antithyroid antibodies, multi-antiepileptic drug hypersensitivity, and good response to immunomodulatory treatment. The relevance of multidrug hypersensitivity in the setting of adult-onset epilepsy and the importance of searching for autoimmune causes for epilepsy are discussed.
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Recurrent status epilepticus associated with Hashimoto's encephalopathy. EPILEPSY & BEHAVIOR CASE REPORTS 2013; 1:113-7. [PMID: 25667842 PMCID: PMC4150643 DOI: 10.1016/j.ebcr.2013.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 06/13/2013] [Accepted: 06/13/2013] [Indexed: 11/20/2022]
Abstract
Hashimoto's encephalopathy (HE) is an infrequent disease with no well-known physiopathology. Status epilepticus is rarely reported in association with HE. We describe the 7-year evolution of a young woman who presented with recurrent status epilepticus as the main complication of HE. This evolution was especially marked by the occurrence of steroid-refractory symptoms and a poor outcome with persistent cognitive and behavioral consequences. We point out that the frontal lobes are especially implicated in these symptoms. This patient highlights the risk of multiple relapses and the need for a long follow-up period. We describe her clinical and paraclinical features, compare this patient to similar case reports, and comment on her outcome.
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Cognitive impairments in Hashimoto's encephalopathy: a case-control study. PLoS One 2013; 8:e55758. [PMID: 23409036 PMCID: PMC3568150 DOI: 10.1371/journal.pone.0055758] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 12/31/2012] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Hashimoto's encephalopathy is considered as a treatable dementia, but it is often misdiagnosed. We investigated cognitive impairment and the MRI pathology of Hashimoto's encephalopathy patients. Methods The study comprised eight patients with Hashimoto's encephalopathy, 16 patients with mild Alzheimer’s disease and 24 healthy subjects. A neuropsychological battery included assessments of memory, language, attention, executive function and visuospatial ability. Cranial MRI was obtained from all Hashimoto's encephalopathy patients. Results Hashimoto's encephalopathy and mild Alzheimer’s disease showed cognitive impairments in episodic memory, attention, executive function and visuospatial ability, but naming ability was unaffected in Hashimoto's encephalopathy. The MRI of Hashimoto's encephalopathy showed leukoencephalopathy-like type or limbic encephalitis-like type; the lesions did not affect the temporal cortex which plays a role in naming ability. Conclusion Except that the naming ability was retained, the impairments in cognitive functions for the Hashimoto's encephalopathy patients were similar to those of Alzheimer’s disease patients. These results were consistent with the MRI findings.
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