Dear hashimoto,
Descriptions of diagnosis and treatment of the rare Hashimoto's
Encephalopathy are very hard to find. Finally, I was able to locate
two texts - one from a Hashimoto's Encephalopathy patient, one from a
collection of medical essays - providing overviews. I have combined
elements from both texts for you. In case you would like to read the
original essays including their bibliographies and references, you
will find links to the respective websites below.
- Hashimoto's Encephalopathy -
Hashimoto's Encephalopathy is a subacute condition associated with
autoimmune thyroiditis. It is a severe and rather infrequent clinical
condition initially described in patients suffering from chronic
lymphocytic thyroiditis. Its origin is still controversial but it can
be agreed to have an autoimmune etiology. In fact, its most
characteristic finding is the high titre of antithyroid antibodies,
especially antimicrosomal. Its presentation varies from focal
neurologic deficits to global confusion. Unlike encephalopathy
associated with hypothyroidism, Hashimoto's encephalopathy responds to
steroid therapy and not thyroxine replacement.
There are some conflicting views by researchers as to Hashimoto's
Encephalopathy being a type of autoimmune cerebral vasculitis, a
neuroimmunological syndrome, a neurological encephalopathy, a
condition that develops due to Hashimoto's Thyroiditis, or perhaps a
disorder that should be classified separately. What is known is that
it is a neuroendocrine disorder - meaning it affects both the
endocrine system, and the neurological (nervous) system.
The neurological symptoms frequently lead to mistaken neurological
diagnoses; furthermore, Hashimoto's encephalopathy, while rare, may
have been underrecognized, since its clinical presentation overlaps
several more common disorders, such as depression, seizures, or
anxiety - it is likely that more cases exist than are actually
properly diagnosed. Hashimoto's Encephalopathy typically have high
antithyroid antibody titers as do patients with Hashimoto's
Thyroiditis, and all patients with Hashimoto's Encephalopathy
eventually are diagnosed with Hashimoto's Thyroiditis as well.
The average age of onset in reported cases is 47 years (range, 14 to
78 years). Approximately 85% of the patients are women. Two types of
clinical presentation can be observed. The first type is characterized
by acute stroke-like episodes with transient focal neurologic deficits
and even epileptic seizures. The second form has a more insidious
onset, progressing to dementia, psychosis, and coma over several
weeks. No focal neurologic deficits are seen in the latter type, but
neuropsychologic testing reveals severe cognitive deficits.
No specific diagnostic test exists for Hashimoto's encephalopathy.
Thyrotropin and FT4 levels should be relatively normal. A positive
antithyroid antibody titer is necessary but not sufficient in making
the diagnosis of Hashimoto's encephalopathy. The presence of other
autoantibodies, such as anti-parietal cell antibody or anti-intrinsic
factor antibody, has been reported. Although nondiagnostic, these
additional autoantibodies can signify an increased likelihood of an
immune-mediated form of encephalopathy.
In about 75% of reported cases, the cerebrospinal fluid reveals an
elevated protein level (range, 0.48 to 2.98 g/L [48 to 298 mg/dL]). Of
these, 25% also have mononuclear pleocytosis (range, 8 to 169 cells).
Oligoclonal bands are detected in 4 of 15 patients for whom such a
result is reported. Glucose level is always normal. Therefore, while
cerebrospinal fluid abnormalities are usually seen in Hashimoto's
Encephalopathy, a normal examination may be present in up to 25% of
cases and does not rule out the condition.
Electroencephalography is abnormal in more than 90% of cases.
Typically, the EEG shows nonspecific, intermittent slow wave activity.
Epileptic activity has been documented in several cases. These
abnormalities do not improve and even worsen after the initiation of
anticonvulsant therapy.
Neuroradiology studies frequently reveal nonspecific findings, such as
bilateral subcortical high signal lesions on T2-weighted images, or
mild cerebral atrophy with temporal predominance. Cerebral angiograms
(reported in 10 cases) and Doppler sonograms of cerebral vasculatures
(reported in 5 cases) are normal.
Many symptoms can occur. Some patients experience many of these
symptoms, others may show some but not all of the symptoms listed
here. Symptoms include:
-Confusion
-Disorientation
-Psychosis
-Coma
-Tremors
-Convulsions
-Concentration Problems
-Attention Span Problems
-Difficulty Retaining Information
-Short Term Memory Problems
-Seizure Activity
-Monoclonal Jerks - Involuntary Muscle Jerks
-Dementia
-Fatigue
-Coordination Difficulties
-Headaches
-Episodes of Stroke
-Episodes of Stroke-Like Deterioration
-Right Sided Hemiparesis - Right Sided Partial Paralysis
-Aphasia - Speech Difficulties
-Articulation Difficulties
-Word Finding Difficulties
-Fine Motor Movement Problems - Coordination of arms, hands, fingers.
Though it is not curable, Hashimoto's Encephalopathy is treatable.
Patients with Hashimoto's Encephalopathy respond dramatically to
steroid therapy. The initial dose of steroids varies between 50 mg and
150 mg of prednisone daily, usually slowly decreased over weeks to
months, depending on the clinical course. While rapid improvement can
be observed within 1 to 3 days, the average time from start of therapy
to significant clinical improvement is 4 to 6 weeks. Most patients
(90%) stay in remission even after treatment has been discontinued
(with follow-up periods of up to 10 years). Hashimoto's Encephalopathy
is a relapsing condition, but the use of oral corticosteroid can keep
the condition manageable for many patients.
-- --
The above text was composed mainly from elements from:
Beverly Seminara - "Hashimoto's Encephalopathy - A Neuroendocrine Disorder"
Original text available on Thyroid-Info
http://www.thyroid-info.com/articles/hashimotos-encephalopathy.htm
Hubert C. Chen, MD, Umesh Masharani, MD, Division of Endocrinology,
University of California at San Francisco - "Hashimoto's
Encephalopathy"
Original text available on Medscape (link to Google Cache version of the website)
://www.google.de/search?q=cache:meyr35GMaYsJ:www.medscape.com/viewarticle/410552_print+%22Hashimoto+encephalopathy%22+diagnosis+treatment&hl=de&ie=UTF-8
Additional sources used:
About.com: Hashimoto's Encephalopathy - A Brief Introduction
http://thyroid.about.com/cs/hashimotos/a/encephalopathy.htm
The Doctor's Doctor: Hashimoto's Thyroiditis
http://www.thedoctorsdoctor.com/diseases/hashimotos.htm
Search terms used:
"Hashimoto encephalopathy"
://www.google.de/search?hl=de&ie=UTF-8&oe=UTF-8&newwindow=1&q=%22Hashimoto+encephalopathy%22&btnG=Google+Suche
"Hashimoto encephalopathy" diagnosis
://www.google.de/search?q=%22Hashimoto+encephalopathy%22+diagnosis&hl=de&lr=&ie=UTF-8&oe=UTF-8&newwindow=1&start=0&sa=N
"Hashimoto encephalopathy" therapy
://www.google.de/search?hl=de&ie=UTF-8&oe=UTF-8&newwindow=1&q=%22Hashimoto+encephalopathy%22+therapy&btnG=Google+Suche
"Hashimoto encephalopathy" treatment
://www.google.de/search?hl=de&ie=UTF-8&oe=UTF-8&newwindow=1&q=%22Hashimoto+encephalopathy%22+treatment&btnG=Google+Suche
Hope this is what you were looking for!
Best regards,
Scriptor |
