Affective psychosis, Hashimoto's thyroiditis, and brain perfusion abnormalities

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Affective psychosis, Hashimoto's thyroiditis, and brain perfusion

abnormalities: case report

Alberto Bocchetta email, Giorgio Tamburini email, Pina Cavolina email,

Alessandra Serra email, Loviselli email and Piga email

Clinical Practice and Epidemiology in Mental Health 2007,

3:31doi:10.1186/1745-0179-3-31

Published: 20 December 2007

PDF <http://www.cpementalhealth.com/content/pdf/1745-0179-3-31.pdf>

(352KB)

Abstract (provisional)

Background

It has recently become evident that circulating thyroid antibodies are

found in excess among patients suffering from mood disorders. Moreover,

a manic episode associated with Hashimoto's thyroiditis has recently

been reported as the first case of bipolar disorder due to Hashimoto's

encephalopathy. We report a case in which Hashimoto's thyroiditis was

suspected to be involved in the deteriorating course of mood disorder

and discuss potential pathogenic mechanisms linking thyroid autoimmunity

with psychopathology.

Case presentation

A 43-year-old woman, with a history of recurrent depression since the

age of 31, developed manic, psychotic, and soft neurological symptoms

across the last three years in concomitance with her first diagnosis of

Hashimoto's thyroiditis. The patient underwent a thorough medical and

neurological workup. Circulating thyroperoxidase antibodies were highly

elevated but thyroid function was adequately maintained with L-thyroxine

substitution. EEG was normal and no other signs of current CNS

inflammation were evidenced. However, brain magnetic resonance imaging

evidenced several non-active lesions in the white matter from both

hemispheres, suggestive of a non-specific past vasculitis. Brain

single-photon emission computed tomography showed cortical perfusion

asymmetry particularly between frontal lobes.

Conclusions

We hypothesize that abnormalities in cortical perfusion might represent

a pathogenic link between thyroid autoimmunity and mood disorders, and

that the rare cases of severe Hashimoto's encephalopathy presenting with

mood disorder might be only the tip of an iceberg.

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