We describe the case of a 14-year-old girl who presented with a 5-year history of hallucinations and depression. She had significantly elevated thyroperoxidase (TPO) antibody titers consistent with the diagnosis of Hashimoto’s thyroiditis. A magnetic resonance imaging (MRI) scan of the brain showed white matter changes affecting the frontal lobe, and cerebral hypoperfusion deficits were observed on serial single-photon emission computed tomography (SPECT) scans. The patient had significant clinical improvement and showed resolution on neuroimaging after corticosteroid treatment. Steroid responsive encephalopathy associated with Hashimoto’s thyroiditis (SREHT) is a more accurate description of the previously named “Hashimoto’s encephalopathy.” This is a condition with neuropsychiatric symptoms associated with high anti-thyroid antibody titers which shows marked improvement following corticosteroid treatment.

The medical evaluation of adolescents who present with psychiatric symptoms requires a full clinical assessment to exclude organic disease. The list of potential etiologies in these patients can be long, particularly if presenting...

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