Hashimoto encephalopathy in pediatric patients: Homogeneity in clinical presentation and heterogeneity in antibody titers.
OBJECTIVE
Hashimoto encephalopathy is an autoimmune encephalopathy characterized by elevated antithyroid antibodies and a favorable response to corticosteroid. This study delineated the clinical characteristics of pediatric Hashimoto encephalopathy and the significance of low antithyroid antibody titers in diagnosis and treatment.


SUBJECTS AND METHODS
Clinical manifestations, antibody titers, and treatment responses were retrospectively reviewed in six consecutive children diagnosed with Hashimoto encephalopathy between August 2008 and July 2016.


RESULTS
Age at diagnosis was 10-17years. Presenting symptoms were seizures, altered consciousness, behavioral changes, psychosis, tremor, and dystonia. Thyroid function was normal in five patients, and one had hypothyroidism prior to the encephalopathy. Antithyroid antibody titer was increased at presentation in five patients and one week later in the other. Antibody levels were extremely varied (anti-thyroglobulin, 20.5-2318.0U/ml; anti-thyroid peroxidase, 12.5-2231.0U/ml; reference range, <60U/ml) and <180U/ml in two patients. Electroencephalogram was abnormal in five patients. Brain magnetic resonance imaging was unremarkable. Four patients responded to high-dose corticosteroid and one improved with additional intravenous immunoglobulin. The remaining patient did not respond to both treatments and normalized after plasmapheresis. Autoantibody titers decreased with treatment response in the acute stage. Two patients with low antibody titers showed similar clinical presentations and responses.


CONCLUSIONS
The clinical presentations and treatment responses in Hashimoto encephalopathy were similar, irrespective of antithyroid antibody titer. Because the initial antithyroid antibody titers can be normal or mildly-elevated, follow-up testing of antithyroid antibodies is required in patients who are clinically suspect for Hashimoto encephalopathy.
['Lee|Jiwon|J|', 'Yu|Hee Joon|HJ|', 'Lee|Jeehun|J|']
D000293:Adolescent D000305:Adrenal Cortex Hormones D001323:Autoantibodies D001324:Autoantigens D001921:Brain D001927:Brain Diseases D002648:Child D004569:Electroencephalography D004660:Encephalitis D005260:Female D050031:Hashimoto Disease D006801:Humans D007453:Iodide Peroxidase D033862:Iron-Binding Proteins D008297:Male D012189:Retrospective Studies D012640:Seizures
Hashimoto encephalopathy Pediatric patients Antithyroid antibody titer Steroid treatment Steroid-responsive encephalopathy associated with autoimmune thyroiditis