Introduction: Hashimoto encephalopathy (HE) is an autoimmune disease with different
neurological and psychiatric characteristics. It is associated with increased
thyroperoxidase autoantibodies. The diagnosis of HE is clinical and involves
the detection of serum thyroperoxidase (TPO) antibodies and the exclusion of
other etiologies. A clinical response to corticosteroid therapy supports the
diagnosis. We report a case of HE revealed by convulsive seizures and cognitive
and behavioral disorders. Observation: She is a 7-year-old child
followed in a neurology unit for convulsive seizures for one year. Clinical
examination performed in the endocrinology unit later found tachycardia without
goiter, behavioral disorders, difficulties to concentrate as well as
psychomotor agitation. Biological work up
revealed subclinical hypothyroidism, positive anti-TPO antibodies with normal thyroid ultrasound and brain MRI. The cerebrospinal fluid was clear, normotensive and absence of pleocytosis. The
sleep-wake electroencephalogram was well
organized for her age with a paroxysmal discharge in the left parieto-temporal
region. Based on these clinical, biological and morphological data, the diagnosis of HE was retained.
Corticosteroid therapy with
prednisone at 1 mg/kg/day was initiated for 6 weeks while reducing the
dose progressively. There was a good clinical and biological progress under treatment. Conclusion: Hashimoto’s
encephalopathy is a rare, but probably unrecognized entity. Over the past
decades, knowledge about thyroid, brain, immunity interactions has increased.
This indicates the importance of a multidisciplinary approach of
endocrinologists, neurologists, psychiatrists and pediatricians for early
recognition and treatment.
References
[1]
Ferracci, F., Bertiato, G. and Moretto, G. (2004) Hashimoto’s Encephalopathy: Epidemiologic Data and Pathogenetic Considerations. Journal of the Neurological Sciences, 217, 165-168. https://doi.org/10.1016/j.jns.2003.09.007
[2]
Archambeaud, F., Galinat, S., Regouby, Y., Magy, L., Rebeyrotte, I., Vallat, J.M. and Teissier, M.P. (2001) Encéphalopathie de Hashimoto. Analyse de quatre observations. La Revue de Médecine Interne, 22, 653-659.
https://doi.org/10.1016/S0248-8663(01)00403-9
[3]
Adams, A.V., Mooneyham, G.C., Van Mater, H. and Gallentine, W. (2020) Evaluation of Diagnostic Criteria for Hashimoto’s Encephalopathy among Children and Adolescents. Pediatric Neurology, 107, 41-47.
https://doi.org/10.1016/j.pediatrneurol.2019.12.011
[4]
Chiarello, P., Talarico, V., Nicoletti, A., Rodio, B., Arcuri, P.P., Bosco, D., Gigliotti, F., Galati, M.C. and Raiola, G. (2020) Hashimoto Encephalopathy: A Case Report and A Short Revision of Current Literature: Hashimoto Encephalopathy in Pediatric Age. Acta Biomedica, 91, e2020087.
[5]
Watemberg, N., Greenstein, D. and Levine, A. (2006) Encephalopathy Associated with Hashimoto Thyroiditis: Pediatric Perspective. Journal of Child Neurology, 21, 1-5. https://doi.org/10.1177/08830738060210010201
[6]
Graham, B.R., Shiff, N., Nour, M., Hasal, S., Huntsman, R. and Almubarak, S. (2016) Hashimoto Encephalopathy Presenting with Stroke-Like Episodes in an Adolescent Female: A Case Report and Literature Review. Pediatric Neurology, 59, 62-70. https://doi.org/10.1016/j.pediatrneurol.2016.02.003
[7]
Castillo, P., Woodruff, B., Caselli, R., Vernino, S., Lucchinetti, C., Swanson, J., Noseworthy, J., Aksamit, A., Carter, J., Sirven, J., Hunder, G., Fatourechi, V., Mokri, B., Drubach, D., Pittock, S., Lennon, V. and Boeve, B. (2006) Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis. Archives of Neurology, 63, 197-202. https://doi.org/10.1001/archneur.63.2.197
[8]
Chaigne, B., Beaufils, E., Jouan, Y., et al. (2012) Encéphalopathie d’Hashimoto. La Revue de Médecine Interne, 33, 390-395.
https://doi.org/10.1016/j.revmed.2012.02.009
[9]
Graus, F., Titulaer, M.J., Balu, R., Benseler, S., Bien, C.G., Cellucci, T., Cortese, I., Dale, R.C., Gelfand, J.M., Geschwind, M., Glaser, C.A., Honnorat, J., Höftberger, R., Iizuka, T., Irani, S.R., Lancaster, E., Leypoldt, F., Prüss, H., Rae-Grant, A., Reindl, M., Rosenfeld, M.R., Rostásy, K., Saiz, A., Venkatesan, A., Vincent, A., Wandinger, K.P., Waters, P. and Dalmau, J. (2016) A Clinical Approach to Diagnosis of Autoimmune Encephalitis. The Lancet Neurology, 15, 391-404.
https://doi.org/10.1016/S1474-4422(15)00401-9
[10]
Churilov, L.P., Sobolevskaia, P.A. and Stroev, Y.I. (2019) Thyroid Gland and Brain: Enigma of Hashimoto’s Encephalopathy. Best Practice & Research Clinical Endocrinology & Metabolism, 33, Article ID: 101364.
https://doi.org/10.1016/j.beem.2019.101364
[11]
Bin Attique, H., Rao, A., Haider, L. and Trivedi, R. (2019) Successful Treatment of Hashimoto Encephalopathy with Therapeutic Plasma Exchange. Therapeutic Apheresis and Dialysis, 24, 599-601. https://doi.org/10.1111/1744-9987.13466
