Hashimoto's encephalopathy-An underdiagnosed disease in psychiatry?

In recent years, research has increasingly focused on inflammatory processes as a trigger for psychiatric illnesses. Contrary to previous suggestions, clinical pictures with psychiatric features only also can occur, leading to erroneous diagnoses and treatments. We describe the case of a patient who was initially diagnosed paranoid schizophrenia on the basis of the clinical presentation. Antipsychotic treatment was frequently discontinued by the patient also due to inadequate response. After intensifying the diagnostic procedures autoimmune thyroiditis oft he Hashimoto type was detected in the patient. Excluding the other causes, Hashimoto's encephalopathy was considered as a differential diagnosis. The patient agreed to a therapeutic attempt with cortison leading to complete remission of psychotic symptoms thus confirming the diagnosis of steroid-responsive encephalopathy associated with autoimmune thyroiditis.