Relationship between Hashimoto's encephalopathy and neuropsychiatric symptoms
Keywords:
ENCEFALOPATÍAS; ENFERMEDADES AUTOINMUNES; TRASTORNOS MENTALES., BRAIN DISEASES; AUTOIMMUNE DISEASES; MENTAL DISORDERS., ENCEFALOPATIAS; DOENÇAS AUTOIMUNES; TRANSTORNOS MENTAIS.Abstract
Introduction: Hashimoto's encephalopathy is an uncommon autoimmune disorder, characterized by the presence of antithyroid antibodies and diverse neuropsychiatric manifestations, which complicates timely diagnosis and clinical management.
Objective: to describe the relationship between Hashimoto's encephalopathy and neuropsychiatric symptoms.
Methods: a descriptive and retrospective systematic review was conducted between 2019 and 2024. The search was performed in international databases (Medline, Embase, Pubmed, Cochrane, Dare), using DeCS and MeSH terms related to hashimoto's encephalopathy, autoimmune encephalopathy, corticosteroids, and neuropsychiatric symptoms. Defined inclusion and exclusion criteria were applied, selecting relevant studies for an appropriate critical analysis.
Development: Hashimoto's encephalopathy is associated with seizures, cognitive decline, psychotic episodes, and behavioral disturbances. Its pathophysiology involves Th17 cells, secretion of proinflammatory cytokines, and activation of immune pathways. Diagnosis relies on excluding other encephalopathies, detecting antithyroid antibodies, and complementary studies. A multidisciplinary approach and early clinical suspicion are essential to optimize prognosis. Corticosteroid therapy shows high efficacy, although up to 25% of patients may be refractory, requiring intravenous immunoglobulins, plasmapheresis, or immunosuppressants.
Conclusions: despite its low prevalence, Hashimoto's encephalopathy represents a diagnostic challenge due to its similarity with primary psychiatric disorders. The identification of antithyroid antibodies and the response to corticosteroids are key diagnostic and therapeutic pillars. Integrating immunological and neuropsychiatric strategies is essential to improve clinical outcomes and prevent recurrences.
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