Delirious Mania Associated with AutoimmuneGastrothyroidal Syndrome of a Mid-Life Female: The Role ofHashimoto Encephalopathy and a 3-Year Follow-Upincluding Serum Autoantibody Levels

We report the case study of a 57-year-old Caucasian female with steroid-responsive encephalopathy associated with autoimmunethyroiditis (SREAT), commonly termed Hashimoto encephalopathy (HE). This presentation includes one of the longest lastingfollow-up studies of HE considering the neuropsychiatric symptoms (here delirium, mania, and EEG-slowing) and their relationto serum autoantibody levels. Antithyroid-peroxidase autoantibodies, the hallmark of autoimmune thyroiditis, were found in theserum and also in the cerebrospinal fluid. Diagnostic analyses found no evidence of limbic encephalopathies characterized by serumantibodies against intracellular, synaptic, or further cell surface antigenic targets, neoplasm, and connective tissue or vasculitisdiseases. A potential contribution of bipolar disorder and metabolic encephalopathies due to severe hypothyroidism, glucocorticoidtreatment, accelerated thyroid hormone replacement therapy, or vitamin B deficiency is critically discussed. Another special featureof this case report is the linkage of HE to an autoimmune polyendocrine syndrome (type 3B) affecting the gastroduodenum inaddition to the thyroid gland.