Hashimoto’s encephalopathy: symptoms, causes and treatment

This neurological disease is related to an alteration of the endocrine system.

Despite the fact that most rare diseases hardly have really 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 combat them.

An example of this is Hashimoto's encephalopathy, which we are going to talk about in the following pages.which we are going to talk about in this article.

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 the following characteristics are characteristic a disconnection of the subject with his environment and alterations of consciousness (which can lead to coma) and confusion (which can lead to coma) and confusion, together with a generally progressive cognitive deterioration in which behavioral alterations, personality changes and alterations in functions such as memory or language also tend to appear.

Although its exact prevalence is unknown, it is estimated to be around 2.1 cases per 100,000 inhabitants and is four to five times more common than other forms of the disease. four to five times more common in women than in men.. In many cases it may occur in subjects with underlying thyroid problems, although others with a history of previous autoimmune diseases or in immunodependent diabetic patients.

Symptoms

The following symptoms are common alterations at the cardiovascular level such as arrhythmias and bradycardias, as well as arterial hypotension.as well as arterial hypotension. Headaches, ataxia, hypotonia, convulsive crises, sleep problems or alterations of sensory perception may also appear.

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

This disorder can appear in different ways, either with an insidious and progressive course, in the form of outbreaks or in a single acute episode. Some of the alterations characteristic of this disease resemble in some cases other conditions with which it may be associated. other conditions with which it can be confused, as for example a hypothyroidism or a very decompensated type 1 diabetes. or a very decompensated type 1 diabetes.

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

This is usually reached after ruling out the presence of other central nervous system problems, metabolic diseases or tumors that better explain the symptomatology, and after confirming the existence of antithyroid antibodies.

Two subtypes

Hashimoto's encephalopathy can present in multiple ways.There are two main types of presentation.

The first one has an insidious onset and a progressive and recurrent character, generating vasculitis and cerebral edema. In this case there are lesions in the Blood vessels of the brainIn this case there are lesions in the blood vessels of the brain, which, together with the hypoperfusion or decrease in the amount of blood reaching the brain, suggest symptoms typical of a stroke.

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

Causes

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

The presence of such antibodies is usually considered essential for diagnosis. Specifically, the presence of anti-peroxidase and anti-thyroglobulin antibodies has been observed to be particularly frequent.

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

However, the presence of thyroid disorders (specifically hypothyroidism) could complicate the severity of Hashimoto's could complicate the severity of symptoms as the thyroid hormone is already in 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 autoantigenic antibodies may be generated within the vascular endothelium of the brain, so that the immune system ends up causing lesions in the brain tissue.

Treatment of this disease

Although Hashimoto's encephalopathy is a complicated disease, patients often have a good response and show great improvement to corticosteroid therapy or administration of corticosteroids, usually steroids. corticotherapy or administration of corticosteroids, usually steroids, for several days.for several days.

Although this therapy usually results in a complete or almost complete improvement, if this does not work, immunosuppressive treatment that eliminates the activity of the immune system on the thyroid hormone will be sought.

However, the presence of cognitive impairment may be persistent in about 25% of cases, and it is advisable to keep a careful follow-up of the case given that relapses are not uncommon..

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

In addition to medical treatment, occupational therapy and rehabilitation or cognitive stimulation may also be necessary in order to strengthen, optimize or help recover neuropsychological functions that may have been altered. Psychotherapy may also be necessarymay also be necessary to treat psychiatric symptoms as well as the psychological affectation that may be generated by the difficulties caused by this disease.