Publication:

A case report of Hashimoto’s encephalitis in a young patient: a diagnostic challenge

Encephalopathy may arise from intrinsic neurological factors or systemic illnesses. The causes can be diverse, with many being reversible. Therefore, prompt identification of the underlying cause is essential for effective patient management. Hashimoto’s encephalopathy, also known as steroid-responsive encephalopathy with autoimmune thyroiditis (SREAT), is characterized by markedly elevated antithyroid peroxidase antibody levels, suggesting an autoimmune origin. The term SREAT reflects its remarkable responsiveness to corticosteroid therapy. Being readily reversible and its response to steroids, Hashimoto's encephalopathy should be taken into consideration when investigating cases of encephalopathies where no definite aetiology is found. Diagnosis involves ruling out other potential causes, including infections, dysglycemia, electrolyte imbalances, myxedema coma, thyroid storm, hypo- and hypercortisolism, among others. This report presents the case of a 25-year-old woman with a history of hypothyroidism who presented with altered consciousness. Following the exclusion of other potential causes, a diagnosis of Hashimoto’s encephalopathy was established, and the patient responded well to intravenous steroid treatment, showing marked clinical improvement. This highlights the importance of considering this differential in treating young hypothyroid patients presenting with altered mental status.