Steroid-Responsive Encephalopathy Associated With Thyroiditis
https://doi.org/10.15605/jafes.041.S1
- Author:
Chua Chong Yee
1
;
Nur Haziqah Baharum
2
;
Fadzliana Hanum Jalal
3
;
Gunavathy Muthusamy
1
Author Information
1. Department of Internal Medicine, Hospital Shah Alam
2. Hospital Al-Sultan Abdullah UiTM
3. Avisena Specialist Hospital
- Publication Type:Journal Article
- MeSH:
Brain Diseases;
Thyroiditis;
Steroids
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):107-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Steroid-responsive encephalopathy associated with
thyroiditis (STREAT) is a rare clinical entity. Clinical
presentations of STREAT can range from a strokelike presentation to psychiatric symptoms. STREAT is
diagnosed based on four major criteria which include
altered cognitive function, new or worsening psychiatric
symptoms, elevated antithyroid antibodies, and exclusion
of infectious, toxic, metabolic, or neoplastic causes. Corticosteroids are the cornerstone of treatment, with reported
excellent response in neurocognitive symptoms resolution.
Case:This was a case of a 48-year-old male with Graves’s disease
who underwent radioiodine therapy 4 months earlier
and was started on levothyroxine 100 mcg 2 weeks prior
to presentation. He presented with 4 days of behavioral
symptoms, irritable mood with auditory and visual
hallucinations. There was no history of fever, headache, limb
weakness, or seizure. On general appearance, the patient
was agitated, talking incoherently, and disorientated with
normal vitals. There was no delayed relaxation of the reflex. The examination of the cranial nerve, motor, sensory, and
cerebellar system was normal. A lumbar puncture showed
normal opening pressure with a high protein CSF content
of 1,596 mg/L. The thyroid-stimulating hormone (TSH) was
elevated at 72.7 uIU/mL and T4 at 9.56 pmol/L. Serum antithyroid peroxidase was elevated at 877.42 IU/mL, and antiTSH receptor antibody at 21.30 IU/L. CSF oligonal band,
serum aquaporin-4, and viral screening were negative; noncontrasted computed tomography brain revealed normal
findings. Based on the clinical history and examination,
a diagnosis of STREAT was made at the emergency
department. The patient was initiated on hydrocortisone
100 mg three times a day. Within 24–48 hours of steroid
therapy, marked improvement and subsequent resolution
of the mental status and behavioral symptoms were seen.
Conclusion:Hashimoto’s thyroiditis can rarely lead to STREAT, a
condition with diverse neurological manifestations, where
early recognition and prompt corticosteroid therapy are
essential for favorable outcomes.
- Full text:2026080417145024538EP_A157.pdf
