Ruken AGACHANLİ, Özlem Devrim BALABAN, Menekse Sila YAZAR, Nezih ERADAMLAR

Psychosis Related with Hashimoto Thyroiditis: a Case Report

Bir olgu sunumu Hashimoto tiroiditi, otoimmun kökenli ve tiroid bezinin inflamasyonu ile karakterize bir hastalıktır. Hashimoto tiroiditi ile birlikte psikiyatrik bozukluklar sıkça görülebilmektedir. Major depresyon %33-43 görülme oranıyla en sık rastlanan duygudurum bozukluğudur. Psikotik bozuklukların birlikte görülme oranı ise %5'tir. Bu yazıda, kısa süre önce hipotiroidi tanısı almış ve hipotirodiye bağlı psikotik bir süreç içine girmiş olan bir vaka tartışılmıştır. Hastanın oral alım reddi olması ve tiroksin preparatının parenteral formunun ülkemizde bulunmaması tedaviyi zorlaştıran etkenler olmuştur. Bu vaka bildiriminde amaç, özellikle ilk psikiyatrik başvuruda rutin laboratuar tetkiklerinin önemini bir kez daha vurgulamak ve parenteral tiroksin preparatının ülkemizde olmamasının, oral alımı reddeden veya oral alamayan hastalarda tedaviyi ne kadar güçleştirdiğinin altını çizmektir

Psychosis related with Hashimoto thyroiditis: a case reportHashimoto's thyroiditis is an autoimmune disease characterized with inflammation of the thyroid gland. Psychiatric symptoms frequently accompany Hashimoto's thyroiditis. Major depression is the most common affective disorder with the prevalence of 33-43%. Psychotic disorders may accompany at 5% rate. In this case report; a patient, recently diagnosed with hypothyroidism and involved into a psychotic process due to his hypothyroidism, is discussed. The patient's refusal of oral intake and lack of parenteral preparation of thyroxine in our country were the factors that made the treatment more complicated. The aim of this case report is to emphasize the importance of the routine laboratory examinations especially during the first admission to the hospital, and to underline difficulty of thyroid replacement therapy due to lack of preparation of parenteral thyroxine in our country in patients who do not or can not get medications orally

PDF

___

Becker KL. Principles and Practices of Endocrinology and Metabolism. Second ed., Philadelphia: J.B. Lippincott Co., 1995; 414-417.

Larsen PR, Davies TF, Hay ID. The thyroid gland. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR (editors). Williams Textbook of Endocrinology. Ninth ed., Philadelphia: Saunders, 1998; 461.

Placidi GPA, Boldrini M, Patronelli A, Fiore E, Chiovato L, Perugi G, Marazziti D. Prevalence of psychiatric disorders in thyroid diseased patients. Neuropsychobiol 1998; 38:222-225. [CrossRef]

Kathol R. Endocrin disorders. In: Runder RJ, Wise MG (editors). Textbook of Consultation Liason Psychiatry. Washington DC: American Psychiatry Press, 1996; 579-586.

Khemka D, Ali JA, Koch CA. Primary hypothyroidism associated with acute mania: case series and literature review. Exp Clin Endocrinol Diabetes 2011; 119:513-517. [CrossRef]

Lin YT, Liao SC. Hashimoto encephalopathy presenting as schizophrenia-like disorder. Cogn Behav Neurol 2009; 22:197- 201. [CrossRef]

Thompson CC, Potter GB. Thyroid hormone action in neural development. Cereb Cortex 2000; 10:939-945.

Ruel J, Faure R, Dussault JH. Regional distribution of nuclear T3 receptors in rat brain and evidence for preferential localization in neurons. J Endocrinol Invest 1985; 8:343-348. [CrossRef]

Heinrich TW, Grahm G. Hypothyroidism presenting as psychosis: Myxedema madness revisited. Prim Care Companion J Clin Psychiatry 2003; 5:260-266. [CrossRef]

Sato T, Imura E, Murata A, Igarashi N. Thyroid hormone- catecholamine interrelationship during cold acclimation in rats. Compensatory role of catecholamine for altered thyroid states. Acta Endocrinol 1986; 113:536-542. [CrossRef]

Chan BL, Singer W. The Hypothalamic-pituitary-thyroid Axis: Clinical and Theoretical Principles. The Thyroid Axis and Psychiatric Illness. Washington DC: American Psychiatric Press Inc., 1993; 147-168.

Whybrow PC, Bauer M. Behavioral, and Psychiatric Aspects of Hypothyroidism. In: Braverman LE, Utiger R (editors). The Thyroid. Eighth ed., Philadelphia: Lippincott, 2000; 643-842.

Whybrow PC, Prange AJ Jr. A hypotheses of thyroid- catecholamine receptor interaction. Arch Gen Psychiatry 1981; 38:106-113. [CrossRef]

Marangell LB, Ketter TA, George MS, Pazzaglia PJ, Callahan AM, Parekh P, Andreason PJ, Horwitz B, Herscovitch P, Post RM. Inverse relationship of peripheral thyrotropin-stimulating hormone levels to brain activity in mood disorders. Am J Psychiatry 1997; 154:224-230. [CrossRef]

Eren I, Cure E, Inanli IC, Kutlucan A, Koroglu BK, Tamer MN. Psychiatric symptom level in clinical and subclinical hypothyroidism and its relation between thyroid hormon levels. Journal of Clinical Psychiatry 2006; 9:131-137. (Turkish)

Asher R. Myxoedematous madness. Brit Med J 1949; 2:555-562. [CrossRef]

Alp R, Saygin M, Ucisik M, Caliskan M. Initial presentation of Hashimoto's thyroiditis with psychotic symptoms: a case report. Bulletin of Clinical Psychopharmacology 2004; 14:83-87. (Turkish)

Dick JP, Guiloff RJ, Stewart A, Blackstock J, Bielawska C, Paul EA, Marsden CD. Mini-mental state examination in neurological patients. J Neurol Neurosurg Psychiatry 1984; 47:496-499. [CrossRef]

Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-198. [CrossRef]

Whybrow PC, Prange AJ Jr, Treadway CR. Mental changes accompanying thyroid gland dysfunction. A reappraisal using objective psychological measurement. Arch Gen Psychiatry 1969; 20:48-63. [CrossRef]

Arrojo M, Perez-Rodriguez M, Mota M, Moreira R, Azevedo A, Oliveira A, Abreu P, Marques P, Silva A, Pereira JG, Palha AP, Baca-Garcia E. Psychiatric presentation of Hashimoto's encephalopathy. Psychosom Med 2007; 69:200-201. [CrossRef]

Wilcox RA, To T, Koukourou A, Frasca J. Hashimoto's encephalopathy masquerading as acute psychosis. J Clin Neurosci 2008; 15:1301-1304. [CrossRef]

Seipelt M, Zerr I, Nau R, Mollenhauer B, Kropp S, Steinhoff BJ, Wilhelm Gössling C, Bamberg C, Janzen RWC, Berlit P, Manz F, Felgenhauer K, Poser S. Hashimoto's encephalitis as a differential diagnosis of Creutzfeld-Jakob disease. J Neurol Neurosurg Psychiatry 1999; 66:172-176. [CrossRef]

Chong JY, Rowland LP, Utiger RD. Hashimoto encephalopathy: syndrome or myth? Arch Neurol 2003; 60:164-171. [CrossRef]

Lin CL, Yang SN, Shiah IS. Acute mania in a patient with hypothyroidism resulting from Hashimoto's Thyroiditis. Gen Hosp Psychiatry 2013; 35:683. [CrossRef]

Damle N, Bal C, Soundararajan R, Kumar P, Durgapal P. A curious case of refractory hypothyroidism due to selective malabsorption of oral thyroxine. Indian J Endocrinol Metab 2012; 16:466-468. [CrossRef]