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Steroid-responsive encephalopathy associated with autoimmune thyroiditis presenting with a postpartum psychosis
  1. Tânia Silva1,
  2. Sofia Ferreira2,
  3. Pedro Esteves2 and
  4. Joaquim Cerejeira1
  1. 1Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  2. 2Psychiatry, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
  1. Correspondence to Dr Tânia Silva;{at}


Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a rare condition characterised by neuropsychiatric symptoms, presence of antithyroid antibodies and significant response to steroid therapy. Postpartum psychosis (PP), although having a low prevalence, is a psychiatrical emergency with potentially serious impact in the mother and children. PP has an atypical presentation when compared with affective or psychotic episodes unrelated to pregnancy. Autoimmune dysfunction is frequent in the postpartum period and is closely related to PP. We report a case of a primiparous woman in her 20s with PP who did not respond to initial treatment with antipsychotics. After reassessment, SREAT was considered in the differential diagnosis. Neuropsychiatric symptoms improved dramatically after 72 hours of treatment with high-dose steroids treatment and the patient was discharged after 16 days. In women with PP, an autoimmune cause must be ruled out before assuming a psychiatry aetiology.

  • delirium
  • thyroid disease
  • psychotic disorders (incl schizophrenia)

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  • Contributors TS—important intellectual content; wrote the paper. PE—data collection and analysis. SF—data collection and analysis. JC—critically for important intellectual content; final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.