Hashimoto's encephalopathy: symptoms, causes and treatment

Despite the fact that for the most part rare diseases hardly have truly effective and specific treatments for them, in some cases Even if the prevalence is low and despite not knowing exactly how they work, medicine has found effective methodologies to fight them.

An example of this is Hashimoto's encephalopathy., which we are going to talk about throughout this article.

• Related article: "Encephalitis: causes, symptoms, treatment and prognosis"

Hashimoto's encephalopathy: what is it?

Hashimoto's encephalopathy is a neurological and autoimmune-based disease considered rare, also linked to the endocrine system as it is associated with thyroid disorders.

This disease is characterized by the presence of an encephalopathy in which are characteristic a disconnection of the subject towards his environment and alterations of consciousness (which can lead to the patient's coma) and confusion, together with generally progressive cognitive deterioration in which also tend to appear behavioral changes, personality changes and alterations in functions such as memory or language.

Although its exact prevalence is unknown, it is estimated at around 2.1 cases per 100,000 inhabitants and It is between four and five times more common in women than in men. In many cases it can appear in subjects with underlying thyroid problems, although other people with a history of previous autoimmune diseases or in immunodependent diabetic patients.

Symptoms

It is common for them to appear cardiovascular disorders such as arrhythmias and bradycardiaas well as arterial hypotension. Headaches, ataxia, hypotonia, seizures, sleep problems or alterations in sensory perception may also appear.

At the psychiatric level, episodes similar to psychotic episodes or dementia are also sometimes observed, as well as emotional lability and mood disorders. Sometimes the symptoms resemble those of a stroke.

This alteration can appear in different ways, either with an insidious and progressive course, in the form of outbreaks or in a single episode at an acute level. Some of the alterations characteristic of this disease are similar in some cases to other conditions with which it can be confused, such as hypothyroidism or very decompensated type 1 diabetes.

The fact that both disorders can also exist comorbidly with Hashimoto's encephalopathy makes it advisable to exercise caution at the time of diagnosis.

This is usually reached after having ruled out the presence of other central nervous system problems, metabolic diseases or tumors that best explain the symptoms, and after confirming the existence of antibodies antithyroid.

two subtypes

Hashimoto's encephalopathy can present in multiple ways, highlighting two types of main presentation.

The first of these has an insidious onset and a progressive and recurrent nature, generating vasculitis and cerebral edema. In this case there are damage to the blood vessels of the brain, which, together with hypoperfusion or a decrease in the amount of blood that reaches the brain, suggest symptoms of a stroke.

Another of the most common presentations appears directly as progressive type encephalopathy and seems to be linked to a greater extent to the passage of antibodies to the brain, generating lesions to the neuronal tissue itself.

• You may be interested in: "Types of neurons: characteristics and functions"

Causes

The exact causes of Hashimoto's encephalopathy and how the disease is triggered is not something by fully known, although the presence of antibodies has been observed in most cases antithyroid. In other words, in almost all the people in whom this disease has been seen, it has been observed that the immune system has created antibodies that attack the hormones that come out of the thyroid.

The presence of such antibodies is usually considered essential for diagnosis. And specifically, the presence of anti-peroxidase and antithyroglobulin antibodies has been observed as especially frequent.

Although the fact that this disease is linked to the thyroid system may suggest people with hiccups or hyperthyroidism, the truth is that a large number of subjects had normal levels of thyroid hormone before the onset of hyperthyroidism. Hashimoto's encephalopathy.

Of course, the presence of thyroid disorders (specifically hypothyroidism) could complicate the severity of symptoms as the thyroid hormone is already basic in a low proportion. It is considered a risk factor to have had previous autoimmune diseases such as systemic lupus erythematosus, and in some cases metabolic disorders such as type 1 diabetes.

It is also speculated that autoantigen antibodies can be generated within the vascular endothelium of the brain, so that the immune system ends up causing lesions in brain tissue.

Treatment of this disease

Despite the fact that Hashimoto's encephalopathy is a complicated disease, patients often have a good response and show great improvement before corticosteroid therapy or administration of corticosteroids, usually steroids, during several days.

Although this therapy usually results in complete or near complete improvement, if it doesn't work an immunosuppressive treatment will be sought to eliminate the activity of the immune system on the hormone thyroid.

However, the presence of cognitive damage can be persistent in around 25% of cases, and it is advisable to keep a careful follow-up of the case since it is not uncommon for there to be relapses.

In addition to the treatment of the underlying autoimmune problem that generates inflammation and tissue alteration as well as destruction of thyroid products, it will be essential to treat the different complications and symptoms that occur in each case. For example, in case of seizures it will be necessary to treat it differentially.

Beyond the medical, the application of occupational therapy and rehabilitation or stimulation may also be necessary in order to strengthen, optimize or help recover neuropsychological functions that may have get upset Psychotherapy may also be necessary, both to treat psychiatric symptoms and the psychological affectation that the difficulties caused by this disease can generate.