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OKAY BACK FROM THE NEUROLOGY WARD 🧠

A 50 Year Old Receptionist Lost Her Energy In Early 2011

She Also Felt Exhausted And No Source Of Stress Was Found

By The End Of That Year She Had Classic Symptoms Of Depression

She Struggled To Concentrate And To Understand Complex Tasks

Her Memory Was Disturbed And She Felt Excessive Guilt

Hopelessness And Social Withdrawal Were Part Of It Too

She Also Slept Badly And Could No Longer Work

Before 2011 She Had No Psychiatric History

Her Family History Showed No Psychiatric Or Autoimmune Illness

Doctors Diagnosed A First Episode Of Major Depression

They Started Her On Venlafaxine Plus Agomelatine

Cognitive Behavioral Therapy Ran Alongside The Medication

Two Years Of Antidepressants And Therapy Did Not Work

In Autumn 2012 She Tried Returning To Work Part Time

Cognitive And Physical Exhaustion Soon Forced Her To Stop

She Was Admitted To The Hospital In January 2014

Her Records Showed High Blood Pressure And A Resolved Slipped Disc

Internal And Neurological Exams Turned Up Nothing Unusual

Blood Tests At The Hospital Found Her Thyroid Antibodies Raised

Her TPO Antibody Level Was 804 IU/mL

A Normal TPO Level Is Under 34 IU/mL

Her Thyroglobulin Antibodies Were 661.4 Against A Normal Limit Of 115

Doctors Ruled Out Limbic Encephalitis And Metabolic Disease

The Authors Describe Her As A Case Of Hashimoto's Encephalopathy

Doctors Also Call The Illness SREAT

SREAT Means A Steroid Responsive Brain Illness Tied To Thyroiditis

The Name Reflects Its Excellent Response To Steroids

Her Case Had No Neurological Signs Alongside The Depression

The Authors Called Her A Unique SREAT Case

She Received High Dose Intravenous Methylprednisolone Over Five Days

An Oral Taper Followed Over The Next Three Weeks

Her Cognitive Symptoms Eased Right After The Steroid Treatment

Mood And Energy Both Returned To Normal After About Five Weeks

After Three Months She Was Fully Back At Work

An Attention Test At 6.5 Months Found No Deficit Left

Her Antibody Levels Fell But Still Topped The Normal Range

Hashimoto's Encephalopathy Is Defined As A Rare Condition

One Review Estimates Its Prevalence At About 2.1 Per 100,000 People

It Affects Women Four To Five Times More Often Than Men

Patients Are On Average Between 45 And 55 Years Old

Cases In Children Have Also Been Reported

It Involves Brain Dysfunction With No Infection Or Structural Change

Ordinary Brain Fog Is Not What This Diagnosis Describes

The Definition Also Requires Positive Thyroid Antibody Tests

Most Cases Bring Signs Her Case Did Not Have

Tremor Appears In About 80 Percent Of Cases

Seizures Appear In About 60 Percent

The Review Calls The Condition Controversial

Its Underlying Cause Is Still Largely Unknown

Several Hypotheses Exist But None Has Been Confirmed

Antibody Levels Do Not Match How Severe The Illness Gets

The Review Says The Antibodies May Be A Side Effect Not A Cause

It Adds That Some Patients Do Not Respond To Steroids

Her Case Report Advises Antibody Tests In Atypical Depression