Encephalopathy of autoimmune origin: SREAT

Background/ObjectiveOur objective is to highlight the importance of identifying symptoms of SREAT, especially in the setting of intermittent cognitive dysfunction, and to inform that SREAT can develop even in patients with a history of partial thyroidectomies.Case ReportWe present a case of a 51-year-old female with a long-standing history of hypothyroidism presenting with acute onset myoclonus, involuntary tremors, fatigue, malaise, and palpitations for two weeks, with intermittent lapses in cognitive function. The patient’s workup is completely within normal limits including her cognition except for elevated TSH levels and markedly elevated levels of anti-thyroid peroxidase (TPO) antibodies, despite having previously had a partial thyroidectomy.DiscussionSteroid-responsive encephalopathy with associated thyroiditis (SREAT) is an autoimmune condition characterized by cognitive dysfunction, elevated thyroid auto-antibodies, and therapeutic response to corticosteroids. SREAT is primarily considered a diagnosis of exclusion. A crucial feature is the hallmark of significant improvement in symptoms when given glucocorticoids. There is a significant correlation between patients with elevated TPO antibodies and new-onset SREAT. Although total thyroidectomy has been reported as a definitive treatment of SREAT, response to corticosteroids is the “sine qua non” in diagnosing this condition.ConclusionHashimoto's thyroiditis can lead to a rare complication called Steroid-Responsive Encephalopathy Associated with Thyroiditis (SREAT), presenting with various neurological symptoms. Prompt glucocorticoid treatment is vital, and a positive response confirms diagnosis. Total thyroidectomy may be necessary for definitive SREAT treatment. More research is needed for alternate treatments and understanding SREAT's pathophysiology.