ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Psychopathology
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1639179
This article is part of the Research TopicAdvances in Clinical Neuropsychology and Interplay with Mental Health in Several Health ConditionsView all articles
Hashimoto's encephalopathy in psychiatric inpatients: Neuropsychiatric Morbidity, Diagnostic Challenges and Treatment
Provisionally accepted
Rifat Serav Ilhan1,2,3*
Kazim Cihan Can1,2,3
Şafak Yalçın Şahiner1,2,3*Burcin Colak1,2,3
Berker Duman1,2,3Yagmur Kir1,2,3Seyda Erdogan1,4,5Rezzak Yilmaz1,4,5
Canan Yücesan1,5,6Mine Araz1,7,8Sena Unal1,10,9Ozlem Dogan1,11,12Gule Cinar1,13,14Emine Uslu1,15,16Meram Can Saka1,2,3- 1Ankara University, Ankara, Türkiye
- 2Department of Psychiatry, Ankara Universitesi Tip Fakultesi, Ankara, Türkiye
- 3Department of Psychiatry, Ankara University Faculty of Medicine, Ankara, Türkiye
- 4Department of Neurology, Ankara Universitesi Tip Fakultesi, Ankara, Türkiye
- 5Department of Neurology, Ankara University Faculty of Medicine, Ankara, Türkiye
- 6Neurology, Ankara Universitesi Tip Fakultesi, Ankara, Türkiye
- 7Department of Nuclear Medicine, Ankara Universitesi Tip Fakultesi, Ankara, Türkiye
- 8Department of Nuclear Medicine, Ankara University Faculty of Medicine, Ankara, Türkiye
- 9Department of Radiology, Ankara Universitesi Tip Fakultesi, Ankara, Türkiye
- 10Department of Radiology, Ankara University Faculty of Medicine, Ankara, Türkiye
- 11Department of Medical Biochemistry, Ankara Universitesi Tip Fakultesi, Ankara, Türkiye
- 12Department of Medical Biochemistry, Ankara University Faculty of Medicine, Ankara, Türkiye
- 13Department of Infectious Disease and Clinical Microbiology, Ankara Universitesi Tip Fakultesi, Ankara, Türkiye
- 14Department of Infectious Disease and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Türkiye
- 15Department of Rheumatology, Ankara Universitesi Tip Fakultesi, Ankara, Türkiye
- 16Department of Rheumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
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Hashimoto's encephalopathy (HE) is a rare neuro-inflammatory disorder that poses a significant diagnostic challenge, particularly when its clinical presentation is dominated by psychiatric symptomatology. This study aimed to delineate the constellation of clinical and paraclinical features that differentiate HE from primary psychiatric disorders among seropositive inpatients, thereby facilitating its early and accurate identification. In this retrospective, single-center study, the records of 484 consecutively admitted female psychiatric inpatients were reviewed. The final cohort comprised 40 patients with confirmed thyroid autoantibody seropositivity. Patients presenting with atypical features or suspected autoimmune etiologies were subjected to a comprehensive neurodiagnostic evaluation, including cerebrospinal fluid (CSF) analysis, electroencephalography (EEG), MRI, and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). The diagnosis of HE was established based on stringent criteria, including the exclusion of alternative etiologies and a definitive therapeutic response to corticosteroids. Of the 40 seropositive patients, nine (22.5%) met the diagnostic criteria for definitive HE. The HE cohort exhibited a significantly later age of psychiatric symptom onset (42.9 vs. 30.1 years; p=0.011) and markedly greater functional impairment (GAF score: 31.7 vs. 51.6; p<0.001) compared to the non-HE group. The most discriminating clinical features were delirium (88.9% in HE vs. 6.5% in non-HE; p<0.001) and catatonia (77.8% vs. 32.3%; p=0.015). Corroborating neurodiagnostic evidence for HE included inflammatory CSF abnormalities (55.6% vs. 0%), diffuse EEG slowing (33.3% vs. 0%), and cortical hypometabolism on FDG-PET (85.7% vs. 0%). All patients with HE were refractory to standard psychiatric interventions but achieved prompt and substantial clinical remission following high-dose corticosteroid administration. In conclusion, HE manifests as a distinct and severe neuropsychiatric syndrome in a subset of seropositive psychiatric inpatients. The emergence of a late-onset clinical picture characterized by a delirium-catatonia complex, particularly when refractory to conventional psychiatric treatment, warrants a high index of suspicion for HE. A multimodal diagnostic approach is essential for accurate identification, enabling the timely initiation of immunotherapy to ameliorate severe neuropsychiatric morbidity and prevent long-term disability
Keywords: Hashimoto's encephalopathy, autoimmune encephalitis, autoimmune psychosis, Catatonia, steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT)
Received: 01 Jun 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Ilhan, Can, Yalçın Şahiner, Colak, Duman, Kir, Erdogan, Yilmaz, Yücesan, Araz, Unal, Dogan, Cinar, Uslu and Saka. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Rifat Serav Ilhan, Ankara University, Ankara, Türkiye
Şafak Yalçın Şahiner, Ankara University, Ankara, Türkiye
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