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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Toppari, Jorma


IMPACT FACTOR 2018: 1.239

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2191-0251
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Volume 28, Issue 5-6

Issues

Hashimoto’s encephalopathy: a rare pediatric brain disease

Ryan M. Farrell
  • Corresponding author
  • Department of Pediatric Endocrinology and Metabolism, 11100 Euclid Ave Old RBC Suite 737, Cleveland, OH 44106, USA
  • Division of Pediatric Endocrinology, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
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  • De Gruyter OnlineGoogle Scholar
/ Michael B. Foster
  • Division of Endocrinology, Department of Pediatrics, University of Louisville, Louisville, KY, USA
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  • De Gruyter OnlineGoogle Scholar
/ Adetokunbo O. Omoruyi
  • Division of Endocrinology, Department of Pediatrics, University of Louisville, Louisville, KY, USA
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  • De Gruyter OnlineGoogle Scholar
/ Suzanne E. Kingery
  • Division of Endocrinology, Department of Pediatrics, University of Louisville, Louisville, KY, USA
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  • De Gruyter OnlineGoogle Scholar
/ Kupper A. Wintergerst
  • Division of Endocrinology, Department of Pediatrics, University of Louisville, Louisville, KY, USA
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Published Online: 2015-01-10 | DOI: https://doi.org/10.1515/jpem-2014-0205

Abstract

We report a 9-year-old female who presented with new onset intractable seizure activity followed by a prolonged encephalopathic state. After ruling out common etiologies, Hashimoto’s encephalopathy (HE) was considered, and antibody levels to thyroid peroxidase and thyroglobulin were both markedly elevated in her serum. She was euthyroid at the time of presentation. Upon treatment with high dose methylprednisolone, the patient demonstrated a significant improvement in her encephalopathy. The diagnosis of HE requires strong clinical suspicion with evidence of antithyroid antibodies, as well as an encephalopathy not explained by another etiology. While well documented in the adult literature, only a handful of pediatric cases have been described to date. Patients with HE have a nearly universal response to high dose glucocorticoids. HE should be considered in the differential diagnosis of any patient, adult or pediatric, who displays prolonged, unexplainable encephalopathy.

Keywords: antithyroglobulin; antithyroid peroxidase; glucocorticoids; Hashimoto’s encephalopathy

References

  • 1.

    Fatourechi V. Hashimoto’s encephalopathy: myth or reality? An endocrinologist’s perspective. Best Pract Res Clin Endocrinol Metab 2005;19:53–66.CrossrefGoogle Scholar

  • 2.

    Mocellin R, Walterfang M, Velakoulis D. Hashimoto’s encephalopathy: epidemiology, pathogenesis and management. CNS Drugs 2007;21:799–811.Web of ScienceCrossrefGoogle Scholar

  • 3.

    Alink J, de Vries TW. Unexplained seizures, confusion or hallucinations: think Hashimoto encephalopathy. Acta Paediatr 2008;97:451–3.Web of ScienceCrossrefGoogle Scholar

  • 4.

    Castro-Gago M, Gomez-Lado C, Maneiro-Freire M, Eiris-Punal J, Bravo-Mata M. Hashimoto encephalopathy in a preschool girl. Pediatr Neurol 2010;42:143–6.CrossrefWeb of ScienceGoogle Scholar

  • 5.

    Yoneda M, Fujii A, Ito A, Yokoyama H, Nakagawa H, et al. High prevalence of serum autoantibodies against the amino terminal of alpha-enolase in Hashimoto’s encephalopathy. J Neuroimmunol 2007;185:195–200.Web of ScienceGoogle Scholar

  • 6.

    Watemberg N, Greenstein D, Levine A. Encephalopathy associated with Hashimoto thyroiditis: pediatric perspective. J Child Neurol 2006;21:1–5.PubMedCrossrefGoogle Scholar

  • 7.

    Chong JY, Rowland LP, Utiger RD. Hashimoto encephalopathy: syndrome or myth? Arch Neurol 2003;60:164–71.CrossrefPubMedGoogle Scholar

  • 8.

    Forchetti CM, Katsamakis G, Garron DC. Autoimmune thyroiditis and a rapidly progressive dementia: global hypoperfusion on SPECT scanning suggests a possible mechanism. Neurology 1997;49:623–6.PubMedCrossrefGoogle Scholar

  • 9.

    Ferracci F, Moretto G, Candeago RM, Cimini N, Conte F, et al. Antithyroid antibodies in the CSF: their role in the pathogenesis of Hashimoto’s encephalopathy. Neurology 2003;60:712–4.CrossrefGoogle Scholar

  • 10.

    Ferracci F, Bertiato G, Moretto G. Hashimoto’s encephalopathy: epidemiologic data and pathogenetic considerations. J Neurol Sci 2004;217:165–8.Google Scholar

  • 11.

    Takahashi S, Mitamura R, Itoh Y, Suzuki N, Okuno A. Hashimoto encephalopathy: etiologic considerations. Pediatr Neurol 1994;11:328–31.CrossrefPubMedGoogle Scholar

  • 12.

    Fatemi S, Bedri J, Nicoloff JT. Encephalopathy associated with Hashimoto’s thyroiditis: use of serum immunoglobulin G as a marker of disease activity. Thyroid 2003;13:227–8.CrossrefGoogle Scholar

  • 13.

    Vander T, Hallevy C, Alsaed I, Valdman S, Ifergane G, et al. 14-3-3 protein in the CSF of a patient with Hashimoto’s encephalopathy. J Neurol 2004;251:1273–4.Google Scholar

  • 14.

    Hernandez Echebarria LE, Saiz A, Graus F, Tejada J, Garcia JM, et al. Detection of 14-3-3 protein in the CSF of a patient with Hashimoto’s encephalopathy. Neurology 2000;54: 1539–40.CrossrefGoogle Scholar

  • 15.

    Shiga Y, Wakabayashi H, Miyazawa K, Kido H, Itoyama Y. 14-3-3 protein levels and isoform patterns in the cerebrospinal fluid of Creutzfeldt-Jakob disease patients in the progressive and terminal stages. J Clin Neurosci 2006;13:661–5.CrossrefGoogle Scholar

  • 16.

    Vasconcellos E, Pina-Garza JE, Fakhoury T, Fenichel GM. Pediatric manifestations of Hashimoto’s encephalopathy. Pediatr Neurol 1999;20:394–8.CrossrefGoogle Scholar

  • 17.

    Byrne OC, Zuberi SM, Madigan CA, King MD. Hashimoto’s thyroiditis – a rare but treatable cause of encephalopathy in children. Eur J Paediatr Neurol 2000;4:279–82.CrossrefGoogle Scholar

  • 18.

    Mamoudjy N, Korff C, Maurey H, Blanchard G, Steshenko D, et al. Hashimoto’s encephalopathy: identification and long-term outcome in children. Eur J Paediatr Neurol 2013;17:280–7.CrossrefGoogle Scholar

  • 19.

    Yuceyar N, Karadeniz M, Erdogan M, Copur A, Akgun A, et al. Thyrotoxic autoimmune encephalopathy in a female patient: only partial response to typical immunosuppressant treatment and remission after thyroidectomy. Clin Neurol Neurosurg 2007;109:458–62.CrossrefWeb of ScienceGoogle Scholar

  • 20.

    Peschen-Rosin R, Schabet M, Dichgans J. Manifestation of Hashimoto’s encephalopathy years before onset of thyroid disease. Eur Neurol 1999;41:79–84.CrossrefGoogle Scholar

About the article

Corresponding author: Ryan M. Farrell, MD, Department of Pediatric Endocrinology and Metabolism, 11100 Euclid Ave Old RBC Suite 737, Cleveland, OH 44106, USA, Phone: +1-216-844-3661, Fax: +1-216-844-8900, E-mail: ; and Division of Pediatric Endocrinology, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA


Received: 2014-05-19

Accepted: 2014-11-24

Published Online: 2015-01-10

Published in Print: 2015-05-01


Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 28, Issue 5-6, Pages 721–724, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2014-0205.

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