From the Research
Hashimoto encephalopathy carries a significant risk of relapse, with approximately 12.5 to 40% of patients experiencing recurrence after initial treatment, as reported in the most recent literature review 1. The risk of relapse in Hashimoto's encephalopathy is a critical consideration in the management of this condition.
- The condition is characterized by a wide range of neurological symptoms, including confusion, decreased state of consciousness, cognitive deficit, seizures, myoclonus, ataxia, and focal neurological deficits.
- Diagnosis is based on the presence of neurological clinical manifestations, increased antithyroid antibodies, and significant clinical improvement after immunomodulation.
- Treatment aims to control the autoimmune process and complications of the disease, with corticosteroids being the first-line treatment.
- Long-term immunosuppressive therapy is typically recommended to prevent relapses, with prednisone at 1-2 mg/kg/day usually initiated during acute episodes, followed by a gradual taper over 6-12 months.
- For maintenance therapy, low-dose prednisone (5-10 mg daily) may be continued for 1-2 years or longer in patients with recurrent disease, as supported by studies such as 2 and 3.
- Steroid-sparing agents such as azathioprine, mycophenolate mofetil, or rituximab can be considered for patients who cannot tolerate steroids or have frequent relapses, as noted in 2 and 4.
- Regular monitoring of thyroid function and anti-thyroid antibody levels is essential, although antibody titers don't always correlate with disease activity, as highlighted in 5 and 1.
- Relapses often present with similar symptoms to the initial episode, including cognitive dysfunction, seizures, stroke-like episodes, or psychiatric manifestations, emphasizing the need for close monitoring and prompt treatment.