Hashimoto’s Encephalopathy Presenting as Catatonia: A Rare Presentation of a Common Disease

Abstract

ABSTRACT A rare type of encephalopathy that typically manifests with neuropsychiatric symptoms is Hashimoto’s encephalopathy, also known as steroid-responsive encephalopathy associated with autoimmune disease (SREAT). The majority of individuals with SREAT are typically euthyroid when they first appear, while the condition can manifest at any level of T3, T4, or thyroid-stimulating hormone. A significant diagnostic factor for this uncommon disorder is elevated thyroid antibodies, which are supported by magnetic resonance imaging (MRI), cerebrospinal fluid analysis (CSF), and electroencephalogram (EEG) results indicative of diffuse encephalopathy. An effective dose of steroids works for the majority of patients. In this case, a 43-year-old woman with rheumatoid arthritis and hypothyroidism who is on disease-modifying medication presented with symptoms that were similar to those of catatonia. After careful consideration, the patient was put on intravenous pulse steroids with the suspicion of SREAT after ruling out other metabolic reasons. Steroid therapy produced a substantial improvement in the patient, who was discharged with a premorbid condition. This case is distinctive due to its appearance, occurrence, therapeutic response, and the existence of another autoimmune illness like rheumatoid arthritis. Hashimoto’s encephalopathy (SREAT) is a rare manifestation of a common disease. According to the Diagnostic and Statistical Manual, our patient was diagnosed with catatonia (DSM-5). She displayed posturing, catalepsy, mutism, stupor, and agitation. It is crucial to comprehend this rare disease, which affects 1 in every 2 lakh people, because it could be confused for a primary psychiatric disorder.