6th Edition of Neurology World Conference 2026

Abstract

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto encephalopathy, is a rare autoimmune condition characterized by heterogeneous neuropsychiatric manifestations and frequently normal neuroimaging and cerebrospinal fluid studies. Diagnostic delays are common, particularly when psychiatric symptoms predominate.

Case Presentation:We report the case of a 59-year-old woman with a history of anxiety and severe alcohol use disorder who presented with acute psychosis, profound behavioral disorganization, agitation, and cognitive impairment. Initial evaluation favored alcohol-related, metabolic, infectious, or primary psychiatric etiologies. Extensive workup—including metabolic panels, toxicology screening, infectious studies, neuroimaging, electroencephalography, and cerebrospinal fluid analysis—was unrevealing. A reactive HIV screening assay and elevated vitamin B12 level further confounded the diagnostic process, though confirmatory testing excluded HIV infection and malignancy. Thyroid evaluation revealed subclinical hypothyroidism with markedly elevated anti–thyroid peroxidase and anti-thyroglobulin antibodies, raising suspicion for autoimmune thyroiditis–associated encephalopathy. Despite normal MRI, EEG, and CSF findings, the constellation of unexplained neuropsychiatric decline and thyroid autoimmunity prompted initiation of high-dose intravenous corticosteroids.
Results:Within 48 hours of corticosteroid therapy, the patient demonstrated dramatic clinical improvement, with resolution of agitation, psychosis, tremor, and disorganized thought processes, and substantial recovery of cognitive function. Subsequent evaluations remained negative for alternative infectious, structural, metabolic, or paraneoplastic causes, supporting the diagnosis of SREAT. Thyroid function later evolved into Hashitoxicosis, reinforcing that encephalopathy was independent of thyroid hormone status.
Conclusion:This case highlights the diagnostic complexity of SREAT and underscores the importance of considering autoimmune encephalopathy in patients with acute, treatment-refractory neuropsychiatric presentations, even in the presence of significant confounders such as substance use and misleading laboratory findings. Early recognition and timely corticosteroid therapy can result in rapid and meaningful neurologic recovery, emphasizing the need for multidisciplinary diagnostic reassessment in complex neuropsychiatric cases.