just curious- who's heard of HE/SREAT?

[finished]

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I'm trying to get a sense of how many neurologists have heard about Hashimoto's Encephalopathy, aka Steroid responsive Encephalopathy Associated with Autoimmune Thyroiditis? Is it being taught in residency programs at all?

I went through medical school with a perplexing, undiagnosed, neurological disease that prolonged my studies and created a lot of self doubt (many doctors thought it was psychosomatic). I had profound fatigue, chronic severe migraines, and mild ataxia that seemed to fluctuate. I was worked up for MS, lupus, and just about every zebra under the sun- except the one I actually have been diagnosed with: HE/SREAT. It was pretty devastating because I did not even know I had the thyroiditis- my TSH had been checked 6 times for various symptoms, but was always normal. So, I was essentially diagnosed with two diseases at once, and the misdiagnsoed thyroiditis was more painful than the encephalopathy. It was my 8th neurologist who tested the antibodies and made the diagnosis. Subsequent ultrasound showed that my thyroid was full of nodules.

I was wondering to what extent it's being taught nowadays, and if so, whether "milder" cases like mine are being recognized (I never had the "textbook" psychosis, seizures, or coma). How often does it come up on rounds? Has anyone seen a case, and if so, what did it look like (symptoms, outpatient versus inpatient, etc)? Does it come up on grand rounds at all? For suspected inpatient cases where you don't have time to wait for the antibody tests to come back, do they do ultrasounds?

Thanks for your help!

 

[neurologist]

Yes, it's being taught. I've seen a couple of cases; it's not something that pops up with any frequency though. The one's I've seen were more severe than your personal symptoms . . . more mental status changes, siezures.

It's one of those things that really reinforces two common sayings in medicine:

#1. Always check the thyroid.

#2. Nobody dies on the neuro ward without a trial of steroids and IVIG first. 😀

 

[moya moya]

I have seen a couple of cases of Hashimoto's encephalopathy during my 2 1/2 years in neurology residency. It is difficult to diagnose if you don't think of it. It is unrelated to thyroid levels and typically is only diagnosed if TPO antibodies or thyroglobulin antibodies are positive, along with a steroid responsive encephalopathy.

 

[typhoonegator]

This is what I do for my patients:

Cut down: grains, dairy, starches. Quick sugar form these sources keep glucose too high for too long, depressing thyroid function, etc.

Natural (prescription) thyroid supplement/support: Armour. Or black or brown seaweed, etc. Synthroid doesn't do the trick.

Cut down, then out: Medications

Essential fatty acids, particularly omega-3 (1-3 grams/day)

Vit. D3 I take 4000 i.u./day

Coenzyme Q-10

Probiotics and digestive enzymes

Anti-fungal: Coconut oil (4 table spoons/day)

Chelate heavy metals, remove mercury amalgum dental fillings.

Medications compound the problem and will never let the person baseline.

Go organic: raw vegetables, turkey, chicken, fish, walnuts, almonds seeds, etc.

Exercise! Elliptical is best (little impact).

You see, medicine both misses and dismisses the reason for hashimotos encephapathy; searching all the crevises of the body, then finally arriving at... Read above again.

Fascinating. Do you have any sources to justify this departure from the standard of care?