CASE REPORT article
Front. Psychiatry
Sec. Adolescent and Young Adult Psychiatry
Hashimoto's Encephalopathy Presenting with Manic and Psychotic Features in a 13-Year-Old Girl: A Case Report
Provisionally accepted
- 1Consultant, Child and Adolescent Psychiatry Department, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
- 2Psychiatry Fellow, Psychiatry Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- 3Psychiatry Resident, Psychiatry Department, King Salman Hospital, Riyadh, Saudi Arabia
- 4Internal Medicine Resident, King Fahad Medical City, Second Health Cluster, Riyadh, Saudi Arabia
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Hashimoto's encephalopathy (HE), also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is a rare autoimmune neuropsychiatric syndrome with highly variable clinical manifestations. Pediatric cases are particularly underrecognized, contributing to diagnostic delays. We describe a 13-year-old female who developed subacute behavioral changes, including withdrawal, emotional lability, and progressive manic and psychotic symptoms over one month. Laboratory evaluation showed markedly elevated antithyroid antibodies with normal thyroid hormone levels, and thyroid ultrasound revealed features consistent with autoimmune thyroiditis. Neuroimaging and cerebrospinal fluid studies were unremarkable. The patient demonstrated rapid and sustained improvement following pulse corticosteroids, intravenous immunoglobulin (IVIG), and low-dose antipsychotics. Her clinical course, combined with serological and imaging findings, supported the diagnosis of Hashimoto's encephalopathy presenting with manic and psychotic features. This case emphasizes the importance of considering HE in the differential diagnosis of acute and subacute onset psychiatric symptoms in children and highlights the diagnostic utility of thyroid antibody testing in such presentations.
Keywords: Hashimoto's encephalopathy, Steroid-responsive encephalopathy (SREAT), Pediatric autoimmune encephalopathy, autoimmune thyroiditis, Thyroid antibodies, Manic symptoms, Acute psychosis
Received: 09 Oct 2025; Accepted: 19 Nov 2025.
Copyright: © 2025 Albdah, Alqahtani, Alamri, Alkhudairy and Alsaman. 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: Abaad Alamri, alamriabaad@gmail.com
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