Hashimoto’s Thyroiditis is an autoimmune thyroid condition that is characterized by elevated thyroid autoantibodies. An encephalopathy is general term for a disease of the brain. Hashimoto’s encephalopathy is an autoimmune condition that not only involves elevated thyroid antibodies, but it also is characterized by brain dysfunction. In fact, the encephalopathy symptoms are usually more prominent than the thyroid symptoms. While Hashimoto’s Thyroiditis is common, Hashimoto’s encephalopathy is a rare condition.
Because there are thyroid autoantibodies present in Hashimoto’s encephalopathy, not surprisingly one can have thyroid hormone imbalances. This can lead to the classic hypothyroid symptoms such as fatigue, weight gain, cold hands and feet, etc. However, many times the person with Hashimoto’s encephalopathy is in a subclinical hypothyroid state, and so while they might have elevated thyroid antibodies, they frequently will present with a normal thyroid panel and minimal hypothyroid symptoms. As I’ll discuss below, other autoantibodies are present as well, which can lead to psychiatric manifestations, seizures and focal neurologic deficits (1).
The Autoantibodies Associated With Hashimoto’s Encephalopathy
Hashimoto’s encephalopathy involves numerous autoantibodies. These can include elevated thyroglobulin antibodies, thyroid peroxidase antibodies, or both. These thyroid antibodies are of course commonly seen in Hashimoto’s Thyroiditis. But with Hashimoto’s encephalopathy, in addition to one or both thyroid autoantibodies being present, there are also autoantibodies against alpha-enolase (2) (3) (4).
Alpha-enolase, also known as Enolase 1, is a glycolytic enzyme. These autoantibodies are found in other autoimmune conditions as well, such as Behçet’s disease (5). Enolase exists in three different forms: α, β and γ (4). Isozyme α is found in most tissues, isozyme β in muscle, and isozyme γ is present mainly in nervous tissue (5) (6). It appears that the antibodies in Hashimoto’s Encephalopathy only involve α-enolase (4).
What’s important to understand here is that autoimmunity involves the body attacking its own cells and tissues. What differentiates one autoimmune condition from another is that different parts of the body are attacked. So with Hashimoto’s the immune system will attack either thyroglobulin, or the thyroid peroxidase enzymes, which is why you will see one or both of these antibodies elevated. With Hashimoto’s encephalopathy you will not only see an increase in one or both of these thyroid antibodies, but since the immune system is attacking alpha-enolase, you will see elevated levels of these autoantibodies as well. As for why one person will develop Hashimoto’s Thyroiditis, while another person will develop Hashimoto’s encephalopathy, it comes down to a combination of genetics, lifestyle factors, and environmental triggers.
What Is The Conventional Treatment Approach?
Corticosteroids are commonly recommended as the first line of treatment in those people with Hashimoto’s encephalopathy (7) (8). And while many people respond very well to corticosteroids, several adverse outcomes, relapses and temporary or permanent spontaneous remissions have also been reported (8). This doesn’t mean that I’m opposed to people using corticosteroids, as while I’m not a big fan of them, I realize that in some cases they might be necessary to take. There have also been a few case studies where intravenous immunoglobulins were beneficial (9) (10), as they help by modulating the immune system.
Can A Natural Treatment Approach Help?
Although conventional medical treatments might be necessary at times to help manage the symptoms, and possibly to help put the person into a state of remission, what we of course need to keep in mind is that treatments such as corticosteroids and intravenous immunoglobulins are not addressing the cause of the problem. As a result, even if the person is put into a state of remission through modulation of the immune system, relapses are common. This was highlighted in a case report I came across that involved a 43-year old woman with Hashimoto’s encephalopathy who experienced three relapses around the time of her menstrual cycle (11).
After the third relapse she was given thyroid hormone medication for her hypothyroidism, and she was also given estrogen and progesterone to help regulate her menstrual cycle. After this she didn’t experience any further relapses. If she were my patient I might have tried to address her problem without giving estrogen and progesterone, but the point I want to get across is that the apparent trigger was addressed in this situation. Unfortunately, addressing the cause of the problem isn’t always this straightforward, but either way, one does want to ideally detect and address the cause of the problem. So if someone has a hormone imbalance, infection, food sensitivity, toxic exposure, or another factor that is triggering the autoimmune response then of course this needs to be addressed.
You might wonder if natural agents can be used instead of corticosteroids and intravenous immunoglobulins. In some people nutritional supplements and herbs can be used to help suppress the autoimmune response, although the cause of the problem still needs to be addressed. But taking things that can reduce proinflammatory cytokines and increase regulatory T cells can help, including fish oils, vitamin D, curcumin, and resveratrol. I’ve discussed this in greater detail in other articles and blog posts, and keep in mind that high doses might be necessary to help suppress the autoimmune component.
In summary, Hashimoto’s encephalopathy is an autoimmune condition that not only involves elevated thyroid antibodies, but it also is characterized by having autoantibodies against alpha-enolase. This in turn can lead to symptoms of brain dysfunction, including psychiatric manifestations, seizures, and focal neurologic deficits. Corticosteroids and intravenous immunoglobulins are two types of conventional treatments, with corticosteroids usually the first option. Natural treatments might also help to put the person into remission, but whether you use natural or conventional methods to control the symptoms, the ultimate goal should be to address and remove the autoimmune trigger.