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Brain
Diagnosis
Pathology-Based Diagnoses
Acquired Toxic/Metabolic/Degenerative Disorders
Toxic, Metabolic, Nutritional, Systemic Diseases With CNS Manifestations
Thyroid Disorders
Thyroid Disorders
Miral D. Jhaveri, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Congenital hypothyroidism (CE)
              • Hashimoto encephalopathy (HE)
              • Pituitary hyperplasia (PH)

            • Synonyms

              • HE: Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT)

            • Definitions

              • Thyroid hormone disorder affecting multiorgan systems

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Churilov LP et al: Thyroid gland and brain: enigma of Hashimoto's encephalopathy. Best Pract Res Clin Endocrinol Metab. 33(6):101364, 2019
                                        2. Ercoli T et al: Status epilepticus in Hashimoto's encephalopathy. Seizure. 70:1-5, 2019
                                        3. Kutluk MG et al: Hashimoto's encephalopathy in children: different manifestations of five cases. Acta Neurol Belg. 119(4):595-9, 2019
                                        4. Li J et al: Hashimoto's encephalopathy and seizure disorders. Front Neurol. 10:440, 2019
                                        5. Feldt-Rasmussen U et al: Interactions between hypothalamic pituitary thyroid axis and other pituitary dysfunctions. Endocrine. 62(3):519-27, 2018
                                        6. Yoneda M: [Hashimoto's encephalopathy and autoantibodies.] Brain Nerve. 70(4):305-14, 2018
                                        7. Nandi-Munshi D et al: 30191443 and complications in children. Pediatr Neurol. 52(4):373-82, 2015
                                        8. Johnston PC et al: Thyrotroph hyperplasia. Postgrad Med J. 90(1059):56-7, 2014
                                        9. Kirshner HS: Hashimoto's encephalopathy: a brief review. Curr Neurol Neurosci Rep. 14(9):476, 2014
                                        10. Mills NJ et al: Reactive pituitary hyperplasia associated with paediatric primary hypothyroidism. J Paediatr Child Health. 49(5):421-2, 2013
                                        11. Zhang WH et al: Magnetic resonance imaging findings of pituitary hyperplasia due to primary hypothyroidism. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 34(5):468-73, 2012
                                        12. Eom KS et al: Primary hypothyroidism mimicking a pituitary macroadenoma: regression after thyroid hormone replacement therapy. Pediatr Radiol. 39(2):164-7, 2009
                                        13. Alves C et al: Primary hypothyroidism in a child simulating a prolactin-secreting adenoma. Childs Nerv Syst. 24(12):1505-8, 2008
                                        14. Khawaja NM et al: Pituitary enlargement in patients with primary hypothyroidism. Endocr Pract. 12(1):29-34, 2006
                                        15. Joshi AS et al: Pituitary hyperplasia secondary to primary hypothyroidism: a case report and review of the literature. Pituitary. 8(2):99-103, 2005
                                        16. Oatridge A et al: Changes in brain size with treatment in patients with hyper- or hypothyroidism. AJNR Am J Neuroradiol. 23(9):1539-44, 2002
                                        17. Bongers-Schokking JJ: Pre- and postnatal brain development in neonates with congenital hypothyroidism. J Pediatr Endocrinol Metab. 14 Suppl 6:1463-8, 2001
                                        18. Constant EL et al: Cerebral blood flow and glucose metabolism in hypothyroidism: a positron emission tomography study. J Clin Endocrinol Metab. 86(8):3864-70, 2001
                                        19. Selim M et al: Ataxia associated with Hashimoto's disease: progressive non-familial adult onset cerebellar degeneration with autoimmune thyroiditis. J Neurol Neurosurg Psychiatry. 71(1):81-7, 2001
                                        20. Papakonstantinou O et al: MR imaging of pituitary hyperplasia in a child with growth arrest and primary hypothyroidism. Eur Radiol. 10(3):516-8, 2000
                                        21. Kinuya S et al: Reversible cerebral hypoperfusion observed with Tc-99m HMPAO SPECT in reversible dementia caused by hypothyroidism. Clin Nucl Med. 24(9):666-8, 1999
                                        22. Shimono T et al: Rapid progression of pituitary hyperplasia in humans with primary hypothyroidism: demonstration with MR imaging. Radiology. 213(2):383-8, 1999
                                        23. Desai MP et al: Pituitary enlargement on magnetic resonance imaging in congenital hypothyroidism. Arch Pediatr Adolesc Med. 150(6):623-8, 1996
                                        24. Wolansky LJ et al: MRI of pituitary hyperplasia in hypothyroidism. Neuroradiology. 38(1):50-2, 1996
                                        25. Gupta RK et al: Brain metabolite changes on in vivo proton magnetic resonance spectroscopy in children with congenital hypothyroidism. J Pediatr. 126(3):389-92, 1995
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Congenital hypothyroidism (CE)
                                                    • Hashimoto encephalopathy (HE)
                                                    • Pituitary hyperplasia (PH)

                                                  • Synonyms

                                                    • HE: Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT)

                                                  • Definitions

                                                    • Thyroid hormone disorder affecting multiorgan systems

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Nuclear Medicine Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Churilov LP et al: Thyroid gland and brain: enigma of Hashimoto's encephalopathy. Best Pract Res Clin Endocrinol Metab. 33(6):101364, 2019
                                                                              2. Ercoli T et al: Status epilepticus in Hashimoto's encephalopathy. Seizure. 70:1-5, 2019
                                                                              3. Kutluk MG et al: Hashimoto's encephalopathy in children: different manifestations of five cases. Acta Neurol Belg. 119(4):595-9, 2019
                                                                              4. Li J et al: Hashimoto's encephalopathy and seizure disorders. Front Neurol. 10:440, 2019
                                                                              5. Feldt-Rasmussen U et al: Interactions between hypothalamic pituitary thyroid axis and other pituitary dysfunctions. Endocrine. 62(3):519-27, 2018
                                                                              6. Yoneda M: [Hashimoto's encephalopathy and autoantibodies.] Brain Nerve. 70(4):305-14, 2018
                                                                              7. Nandi-Munshi D et al: 30191443 and complications in children. Pediatr Neurol. 52(4):373-82, 2015
                                                                              8. Johnston PC et al: Thyrotroph hyperplasia. Postgrad Med J. 90(1059):56-7, 2014
                                                                              9. Kirshner HS: Hashimoto's encephalopathy: a brief review. Curr Neurol Neurosci Rep. 14(9):476, 2014
                                                                              10. Mills NJ et al: Reactive pituitary hyperplasia associated with paediatric primary hypothyroidism. J Paediatr Child Health. 49(5):421-2, 2013
                                                                              11. Zhang WH et al: Magnetic resonance imaging findings of pituitary hyperplasia due to primary hypothyroidism. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 34(5):468-73, 2012
                                                                              12. Eom KS et al: Primary hypothyroidism mimicking a pituitary macroadenoma: regression after thyroid hormone replacement therapy. Pediatr Radiol. 39(2):164-7, 2009
                                                                              13. Alves C et al: Primary hypothyroidism in a child simulating a prolactin-secreting adenoma. Childs Nerv Syst. 24(12):1505-8, 2008
                                                                              14. Khawaja NM et al: Pituitary enlargement in patients with primary hypothyroidism. Endocr Pract. 12(1):29-34, 2006
                                                                              15. Joshi AS et al: Pituitary hyperplasia secondary to primary hypothyroidism: a case report and review of the literature. Pituitary. 8(2):99-103, 2005
                                                                              16. Oatridge A et al: Changes in brain size with treatment in patients with hyper- or hypothyroidism. AJNR Am J Neuroradiol. 23(9):1539-44, 2002
                                                                              17. Bongers-Schokking JJ: Pre- and postnatal brain development in neonates with congenital hypothyroidism. J Pediatr Endocrinol Metab. 14 Suppl 6:1463-8, 2001
                                                                              18. Constant EL et al: Cerebral blood flow and glucose metabolism in hypothyroidism: a positron emission tomography study. J Clin Endocrinol Metab. 86(8):3864-70, 2001
                                                                              19. Selim M et al: Ataxia associated with Hashimoto's disease: progressive non-familial adult onset cerebellar degeneration with autoimmune thyroiditis. J Neurol Neurosurg Psychiatry. 71(1):81-7, 2001
                                                                              20. Papakonstantinou O et al: MR imaging of pituitary hyperplasia in a child with growth arrest and primary hypothyroidism. Eur Radiol. 10(3):516-8, 2000
                                                                              21. Kinuya S et al: Reversible cerebral hypoperfusion observed with Tc-99m HMPAO SPECT in reversible dementia caused by hypothyroidism. Clin Nucl Med. 24(9):666-8, 1999
                                                                              22. Shimono T et al: Rapid progression of pituitary hyperplasia in humans with primary hypothyroidism: demonstration with MR imaging. Radiology. 213(2):383-8, 1999
                                                                              23. Desai MP et al: Pituitary enlargement on magnetic resonance imaging in congenital hypothyroidism. Arch Pediatr Adolesc Med. 150(6):623-8, 1996
                                                                              24. Wolansky LJ et al: MRI of pituitary hyperplasia in hypothyroidism. Neuroradiology. 38(1):50-2, 1996
                                                                              25. Gupta RK et al: Brain metabolite changes on in vivo proton magnetic resonance spectroscopy in children with congenital hypothyroidism. J Pediatr. 126(3):389-92, 1995