Work

Hashimoto’s encephalopathy presenting with manic and psychotic features in a 13-year-old girl: a case report

Year: 2026

Type: article

Abstract: Hashimoto's encephalopathy (HE), also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is a rare autoimmune neuropsychiatric syndrome with highly variable clinical manifestations. Pediatric cases are particularly underrecognized, contributing to diagnostic delays. We describe a 13-year-old female patient who developed subacute behavioral changes, including withdrawal, emotional lability, and progressive manic and psychotic symptoms, over 1 month. Laboratory evaluation showed markedly elevated antithyroid antibodies with normal thyroid hormone levels, and thyroid ultrasound revealed features consistent with autoimmune thyroiditis. Neuroimaging and cerebrospinal fluid studies were unremarkable. The patient demonstrated rapid and sustained improvement following pulse corticosteroids, intravenous immunoglobulin (IVIG), and low-dose antipsychotics. Her clinical course, combined with serological and imaging findings, supported the diagnosis of HE presenting with manic and psychotic features. This case emphasizes the importance of considering HE in the differential diagnosis of acute and subacute onset psychiatric symptoms in children and highlights the diagnostic utility of thyroid antibody testing in such presentations. Categories: Pediatrics; Psychiatry; Neurology; Endocrinology; Immunology.

Source: Frontiers in Psychiatry

DOI: 10.3389/fpsyt.2025.1721056

Authors: Ayman Albdah, Reem AlQahtani, Abaad Alamri, Faris A. Alkhudairy, Majd Alsaman

Institutions: King Khalid University, King Fahd Medical City

Language: English

Topic: Autoimmune Neurological Disorders and Treatments

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801