8. The Third Time's the Charm

  1. James C. Pile4,
  2. Thomas E. Baudendistel5 and
  3. Brian J. Harte6
  1. Sara Mekuria1,
  2. Esteban Cheng Ching2,
  3. S. A. Josephson3,
  4. Jinny Tavee2 and
  5. Brian J. Harte6

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch8

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Mekuria, S., Ching, E. C., Josephson, S. A., Tavee, J. and Harte, B. J. (2013) The Third Time's the Charm, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch8

Editor Information

  1. 4

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 5

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 6

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio, USA

  2. 2

    Department of Neurology, Cleveland Clinic, Cleveland, Ohio, USA

  3. 3

    Department of Neurology, University of California, San Francisco, California, USA

  4. 6

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

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Keywords:

  • autoimmune encephalopathies;
  • cognitive deterioration;
  • corticosteroids;
  • Hashimoto's encephalopathy (HE);
  • steroid-responsive encephalopathy associated with autoimmune thyroiditis;
  • thyroid autoimmunity

Summary

Hashimoto's encephalopathy (HE) is an uncommon condition that can present with a rapidly progressive decline and should be considered in patients who present with recurrent mental status changes in the setting of normal imaging studies and routine laboratory results. The entity, in the most recent terminology, is known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT). It is characterized by an acute or subacute encephalopathy associated with thyroid autoimmunity. Patients typically present with fluctuating symptoms, episodes of confusion, alterations of consciousness, and rapid cognitive decline. Different approaches to the treatment of HE have been recommended. As the acronym SREAT suggests, patients typically respond dramatically to high-dose steroid therapy.