Hashimoto encephalopathy: symptoms, causes and treatment

While the majority of rare diseases barely have truly effective and specific treatments for them, in some cases, even though the prevalence is low and without knowing exactly how medicine works, they have found effective methodologies to combat them.

Hashimoto’s encephalopathy is an example, Which we will talk about throughout this article.

    Hashimoto’s encephalopathy: what is it?

    Hashimoto’s encephalopathy is a neurological and autoimmune disease considered rare, also linked to the endocrine system in the finding associated with thyroid disorders.

    This disease is characterized by the presence of encephalopathy in which they are characteristic a disconnection of the subject from his environment and alterations of consciousness (Which can lead to coma of the patient) and confusion, as well as cognitive impairment of a generally progressive nature in which also tend to appear alterations in behavior, changes in personality and alterations in functions such as memory or language.

    Although its exact prevalence is unknown, it is estimated to be around 2.1 cases per 100,000 population and it is four to five times more common in women than in men. In many cases, it can appear in people with underlying thyroid problems, although others with a history of autoimmune diseases, or in patients with diabetes who are immune-dependent.


    It is common for them to introduce themselves cardiovascular disorders such as arrhythmias and bradycardia, As well as hypotension. Headaches, ataxia, hypotonia, seizures, sleep disturbances or impaired sensory perception can also occur.

    At the psychiatric level, episodes similar to psychotic attacks or dementias are sometimes observed, as well as emotional lability and mood disorders. Sometimes the symptoms are similar to those of a stroke.

    This alteration can appear in different ways, either with an insidious and progressive course, in the form of epidemics or in a single episode at the acute level. Some of the disorders of this disease are in some cases similar to other conditions you might be confused with, such as hypothyroidism or severely decompensated type 1 diabetes.

    The fact that in addition the two disorders can coexist with Hashimoto encephalopathy, one should be careful at the time of diagnosis.

    This is usually done after ruling out the presence of other central nervous system problems, metabolic diseases, or tumors that best explain the symptoms, and after confirming the existence of anti-thyroid antibodies.


    Hashimoto’s encephalopathy can present in several ways, Highlighting two main types of presentation.

    The first of them has an insidious onset and a progressive and recurrent character, generating vasculitis and cerebral edema. In this case injuries to blood vessels in the brain, Which one and next to hypoperfusion or decrease in the amount of blood reaching the brain makes you think of the symptoms of a stroke.

    Another of the most common presentations appears directly as a progressive type encephalopathy and it seems more closely related to the passage of antibodies in the brain, Causing damage to the neural tissue itself.


      The exact causes of Hashimoto’s encephalopathy and how the disease is triggered are not completely known, although the presence of anti-thyroid antibodies has been observed in most cases. In other words, in almost all people in whom this disease has been observed, it has been observed that the immune system has created antibodies that attack hormones coming out of the thyroid.

      The presence of these antibodies is generally considered essential for diagnosis. More specifically, the presence of anti-peroxidase and anti-pyroglobulin antibodies has been observed to be particularly frequent.

      While the fact that this disease is related to the thyroid system may suggest that people with hiccups or hyperthyroidism, the truth is that many people had normal levels of thyroid hormones before the onset of encephalopathy.

      Of course, the presence of thyroid disorders (especially hypothyroidism) could complicate the severity of symptoms being the thyroid hormone already basic in low proportion. It is considered a risk factor for having previously had autoimmune diseases such as systemic lupus erythematosus and, in some cases, metabolic disorders such as type 1 diabetes.

      It is also believed that self-antigenic antibodies can be generated in the vascular endothelium of the brain, so that the immune system ends up damaging brain tissue.

      Treatment of this disease

      Although Hashimoto’s encephalopathy in complicated disease, patients often have a good response and show great improvement in the face of corticosteroid therapy or administration of corticosteroids, usually steroids, For several days.

      Although this therapy usually results in complete or almost complete improvement, in case this does not work, immunosuppressive therapy will be sought to eliminate the activity of the immune system on the thyroid hormone.

      However, the presence of cognitive impairment can be persistent in about 25% of cases, and it is advisable to keep a close eye on the case because it is not uncommon for relapses to occur.

      In addition to treating the underlying autoimmune problem that generates inflammation and tissue damage in addition to the destruction of thyroid products, it will be imperative to address the various complications and symptoms that present themselves in each case. For example, in case of seizures, it will be necessary to treat it differently.

      Beyond the physician, it may also be necessary to apply occupational therapy and rehabilitation or cognitive stimulation in order to strengthen, optimize or help recover possibly impaired neuropsychological functions. Psychotherapy may also be necessary, Both to treat psychiatric symptoms and psychological disorders that can generate difficulties caused by this disease.

      Bibliographical references:

      • Mantilla, SR, Guerrero, A., Montoya, LI, Giraldo, K and Aguirre, HD (2018). Hashimoto’s encephalopathy: case report and review of the literature. Neurology Argentina.
      • Pinedo-Torres, I. and Pau-Ibarra, JL (2018). Current knowledge on Hashimoto’s encephalopathy: a review of the literature. Medwave, 18 (6).
      • Singh, K. and Kashyap, S. (2003). Hashimoto encephalopathy. The Lancet: 361.

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