SHM Converge Scientific Abstract ePoster Gallery-Hashimoto's Encephalopathy With Psychosis: When Treatment Worsens Symptoms

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This case report describes Steroid-Responsive Encephalopathy associated with Autoimmune Thyroiditis (SREAT), also known as Hashimoto’s encephalopathy, a rare diagnosis of exclusion marked by cognitive decline, psychiatric symptoms, and elevated anti-thyroid antibodies.<br /><br />A 59-year-old woman with no prior psychiatric or significant medical history developed subacute progressive cognitive and psychomotor decline with auditory and visual hallucinations. Extensive initial workup, including toxicology, blood studies, autoimmune testing, cerebrospinal fluid studies, and neuroimaging (CT, MRI, PET), was unrevealing. Thyroid-stimulating hormone was normal, but anti-thyroglobulin and anti-thyroperoxidase antibodies were markedly elevated, supporting a diagnosis of SREAT. She improved after intravenous immunoglobulin and was discharged, but later relapsed when she did not adhere to treatment and was restarted on high-dose steroids.<br /><br />Her psychosis worsened over 48 hours, creating diagnostic uncertainty. In an interdisciplinary meeting, Neurology reaffirmed SREAT and the need for steroid treatment, while Psychiatry recommended continuing olanzapine to help manage possible steroid-induced psychosis. With this combined approach, the patient improved substantially and was discharged 10 days later with better cognition. At two-month follow-up, her psychosis had completely resolved, she had returned to independent functioning, and thyroid studies remained normal, though mild executive dysfunction persisted.<br /><br />The report emphasizes that high-dose steroids, while necessary for SREAT, can precipitate psychiatric side effects that complicate assessment of recovery. It highlights the value of interdisciplinary care—especially coordination between Neurology and Psychiatry—to create a unified treatment plan and improve outcomes.

Asset Subtitle

Adam J. Haley

Meta Tag

Author List Adam J. Haley, Jessica Corder, Stephen Nnodim

Category Clinical Vignettes

Concept Hashimoto Encephalopathy

Concept Diagnosis of Exclusion

Concept Corticosteroid

Concept Cognitive Decline

Concept Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization Naval Hospital Camp Lejeune

Presenting Author Adam J. Haley

Track Adult

Keywords

SREAT

Hashimoto encephalopathy

autoimmune thyroiditis

steroid-responsive encephalopathy

cognitive decline

psychosis

anti-thyroglobulin antibodies

anti-thyroperoxidase antibodies

intravenous immunoglobulin

interdisciplinary care

Hashimoto Encephalopathy

Diagnosis of Exclusion

Corticosteroid

Cognitive Decline

Neurologic Deficit