Psychiatric Presentations Heralding Hashimoto’s Encephalopathy: A Systematic Review and Analysis of Cases Reported in Literature

Abstract

Hashimoto's encephalopathy (HE) may often present initially with psychiatric symptoms. These presentations are often variable in clinical aspects, and there has been no systematic analysis of the numerous psychiatric presentations heralding an eventual diagnosis of HE which will guide clinicians to make a correct diagnosis of HE. This systematic review was done to analyze the demographic characteristics, symptom typology, and clinical and treatment variables associated with such forerunner presentations. Electronic databases such as PubMed, ScienceDirect, and Google Scholar databases were searched to identify potential case reports that described initial psychiatric presentations of HE in English language peer-reviewed journals. The generated articles were evaluated and relevant data were extracted using a structured tool. We identified a total of forty articles that described 46 cases. More than half of the total samples (54.4%) were above the age of 50 years at presentation. The most common psychiatric diagnosis heralding HE was acute psychosis (26.1%) followed by depressive disorders (23.9%). Dementia (10.9%) and schizophrenia (2.2%) were uncommon presentations. Antithyroid peroxidase antibodies were elevated in all patients but not antithyroglobulin antibodies. Preexisting hypothyroidism was absent in majority of cases (60.9%). Steroid doses initiated were 500–1000 mg of intravenous methylprednisolone for majority (52.1%) of patients while oral steroid maintenance was required for a significant minority (39.1%). Psychiatric manifestations of HE may be heterogeneous and require a high index of clinical suspicion, especially in older adults. A range of clinical and treatment variables may assist clinicians in making a faster diagnosis and instituting prompt and effective management.

Autoimmune encephalitis as a differential diagnosis of schizophreniform psychosis: clinical symptomatology, pathophysiology, diagnostic approach, and therapeutic considerations

“…In the meantime, cases with isolated anti-NMDA-R Ab detection in the serum and typical [ 18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) alterations were published [28]. In a case collection of 46 classic psychiatric Hashimoto encephalopathy cases, 12 patients suffered from acute psychosis (26.1%), and one patient met the criteria for schizophrenia (2.2%) [59]. Abs against intracellular antigens also may be associated with classical schizophreniform syndromes in rare individual cases [24,60].…”

Psychotic Symptoms of Hashimoto’s Encephalopathy: A Diagnostic Challenge

“…Table 4. Investigations in Hashimoto's encephalopathy [1,3,5] Varied, hypothyroidism commoner [1,5] TFT Thyroid peroxidase antibodies ＞1000 IU/L, not a specific marker, epiphenomenon of another autoimmune process [4] Anti NAE antibodies Specificity 91% [5] CSF Elevated proteins, lymphocytes [1] EEG Diffuse slowing (most common) [1] MRI Nonspecific [1] MRA Narrowing of cerebral blood vessels [1] CSF: cerebrospinal fluid, EEG: electroencephalography, NAE: NH2 terminal alpha enolase, MRA: MR angiography, TFT: thyroid function test…”

“…Onset of HE could be acute or subacute, with a progressive or relapsing-remit- ting course [1]. Thyroid complications vary, with 55% of patients presenting with hypothyroidism [1,3]. Clinical features are non-specific and are highlighted in Table 2 and Figs.…”

Hashimoto’s Encephalopathy Mimicking Viral Encephalitis: A Case Report

“…Hashimoto's encephalopathy (HE) is a rare neuropsychiatric syndrome associated with thyroid antibodies and was first reported by Brain in 1996(Brain et al, 1966. HE presents with a broad range of clinical symptoms, including neurological manifestations such as strokelike episodes, seizures, confusion, myoclonus, ataxia, tremors, and dementia, as well as psychiatric manifestations, including acute psychosis, depressive disorders, personality changes, hallucinations, and schizophrenia (Kirshner, 2014;Menon et al, 2017). In this case report, we describe a patient with HE whose clinical symptoms and laboratory test results mimicked viral encephalitis.…”