Objective:

Presented here is the case of a 54-year-old male with a history of testicular cancer, who was admitted to the Department of Neurology with three months of seizures and acute psychosis. After exhaustive evaluations, including anti-thyroid antibody tests, a diagnosis of SREAT was suspected. The patient exhibited remarkable improvement within days of initiating treatment with high-dose steroids and intravenous immunoglobulin (IVIG), confirming the diagnosis.

Background:

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto’s Encephalopathy (HE), is an exceptionally rare autoimmune condition characterized by elevated serum anti-thyroid antibodies in the context of new-onset encephalopathy. Despite its rarity, prompt recognition and diagnosis are crucial due to its potential for swift and significant improvement with immunomodulating therapies.

Design/Methods:

The diverse presentation of SREAT, including seizures, psychosis, and neurological deficits, often complicates diagnosis. Notably, the diagnostic criteria, involving the presence of anti-thyroid antibodies in suspected autoimmune encephalitis, remain controversial. However, the rapid response to immunomodulating therapies, as observed in this case, strengthens the argument for the accuracy of the diagnosis.

Results:

SREAT’s rarity and variable symptoms emphasize the need for heightened clinical suspicion when encountering patients with unexplained seizures or psychosis. Including serum anti-thyroid antibodies in the initial diagnostic workup could facilitate faster diagnosis, enabling prompt treatment initiation.

Conclusions:

In this instance, the patient's swift diagnosis and treatment initiation highlight the potential benefits of integrating anti-thyroid antibody testing into the diagnostic process, expediting accurate identification and ensuring timely intervention for this challenging and often misunderstood condition.