Psychotic Symptoms of Hashimoto's Encephalopathy: A Diagnostic Challenge

Hashimoto's encephalopathy (HE) is a rare and underdiagnosed neuropsychiatric illness. We present the case of a 17-year-old girl who was admitted to a tertiary-care psychiatric center with acute onset psychosis and fever. Her psychotic symptoms were characterized by persecutory and referential delusions, as well as tactile and visual hallucinations. Her acute behavioral disturbance warranted admission and treatment in a psychiatric setting (risperidone tablets, 3 mg/day). She had experienced an episode of fever with a unilateral visual acuity defect approximately 3 years before admission, which was resolved with treatment. Focused clinical examination revealed an enlarged thyroid, and baseline blood investigations, including thyroid function test results were normal. Abnormal laboratory investigations revealed elevated anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) levels (anti-TPO of 480 IU/mL; anti-TG of 287 IU/mL). Results of other investigations for infection, including cerebrospinal fluid examination, electroencephalography, and brain magnetic resonance imaging were normal. She was diagnosed with HE and was treated with intravenous corticosteroids (methylprednisolone up to 1 g/day; tapered and discontinued after a month). The patient achieved complete remission of psychotic symptoms and normalization of the anti-thyroid antibody titers. Currently, at the seventh month of follow-up, the patient is doing well. This case highlights the fact that in the absence of well-defined clinical diagnostic criteria, a high index of suspicion is required for early diagnosis of HE. Psychiatrists need to explore for organic etiologies when dealing with acute psychiatric symptoms in a younger age group.

Thyroglobulin antibody is associated with elevated risk of papillary thyroid cancer among female patients / 中华内分泌代谢杂志

Objective To determine the correlation between papillary thyroid cancer( PTC) malignancy with thyroid antibody expression level. Methods In this retrospective study, 4046 goiter patients with complete clinical data who have undergone thyroidectomy were separated into the benign nodule ( n=1357) and PTC groups ( n=2689), and their preoperative thyroglobulin antibody ( TgAb) and thyroid peroxidase antibody ( TPOAb) were assessed through antibody analysis. HT was determined based on the postoperative histopathology. The collected data were then evaluated for the correlation with PTC malignancy through statistical tests. Results In general, patients in the PTC group showed a significantly higher TgAb positivity ( 10. 9％) than those in the benign group ( 5. 6％, P<0.01) . Among female patients, a higher TgAb positivity was observed for those in the PTC group than those in the benign group (14.0％ vs 7.0％, P<0.01), while no significant difference between groups was observed in male patients. The high odds ratio of 2.18 supports the significant correlation between TgAb-positive status and higher risk of developing PTC in women (P<0.05). However, the risk of developing PTC was not correlated with higher TgAb titre. TgAb was not significantly correlated with the mass size, multifocality, lymph node metastasis or the TNM classification of malignant tumor stage Ⅲ/Ⅳ. Conclusion The increasing risk of PTC is related to TgAb among female patients, but it will not increase as TgAb titer rises. It is not associated with PTC aggressiveness.

Associations of urinary iodine and blood selenium levels with subclinical hypothyroidism and thyroid antibodies during the first half pregnancy in Tianjin women / 中华内分泌代谢杂志

Objective To investigate the associations of urinary iodine concentration ( UIC) and blood selenium levels with subclinical hypothyroidism and thyroid antibodies during the first half pregnancy in women. Methods A total of 239 pregnant women(7-20 weeks)were selected. The baseline data were collected, and serum TSH, FT4 , thyroid peroxidase antibody ( TPOAb), thyroglobulin antibody ( TgAb), blood selenium, and urinary iodine concentration(UIC) levels were measured. Results The median level of urinary iodine among 239 women was 156. 96 μg/ L. The distributions of pregnant women with iodine deficiency, iodine adequate, more-than-adequate or excessive iodine intake were 43. 9％ , 38. 9％ , 17. 2％ , respectively. The percentage of more-than-adequate and excessive iodine in women with subclinical hypothyroidism was higher than that in women with euthyroidism. The serum TSH level in women with UIC≥250 μg/ L was higher than those with 150≤UIC<250 μg/ L and UIC<150 μg/ L (P<0. 05). The serum TSH level in women with blood selenium<95 μg/ L was higher than those with selenium≥95μg/ L(P<0. 05). Logistic regression analysis showed that the risk of subclinical hypothyroidism in women with UIC≥250 μg/ L was increased by 3. 498 fold(95％ CI 1. 588-7. 704)as compared with those with 150≤UIC<250 μg/ L. The risk of subclinical hypothyroidism in women with blood selenium <80 μg/ L was increased by 2. 667 fold (95％ CI 1. 123-6. 331) compared with those with 90 ≤ selenium < 100 μg/ L. After adjusting for age, gestational weeks, residential district, TPOAb, TgAb, taking compound nutritional supplements, more-than-adequate and excessive iodine still increased the risk of subclinical hypothyroidism(OR= 3. 014, 95％ CI 1. 310-6. 938). Women with UIC≥250 μg/ L and blood selenium <95 μg/ L revealed the increased risk of subclinical hypothyroidism as compared to those with 150≤UIC<250 μg/ L and selenium≥95 μg/ L(OR=5. 429, 95％ CI 1. 929-15. 281). After adjusting for age, gestational weeks, residential district, TPOAb, TgAb, taking compound nutritional supplements, the fingdings still existed. Conclusion The nutrient condition of iodine and selenium of the pregnant women in Tianjin during the first half pregnancy should be noticed. The individualized supplement of iodine and selenium, if needed, should be performed to decrease the risk of subclinical hypothyroidism.

Is there an association between thyroid function abnormalities and breast cancer?

ABSTRACT Objective The aim of this study was to evaluate the association between thyroid function abnormalities and breast cancer and, in particular, the prognostic markers of breast cancer.. Subjects and methods Baseline levels of thyrotropin, free triiodothyronine, free thyroxine and thyroid autoantibodies were measured in 97 women with primary breast cancer, 27 women with benign breast disease, and 4 women with atypical ductal hyperplasia. Their baseline levels were compared with those in 48 healthy women with a normal mammography in the last 2 years. Results There were no significant associations between history of thyroid disease and breast cancer (p = 0.33). The mean baseline levels of triiodothyronine and thyrotropin did not differ significantly between the compared groups. The mean baseline levels of free thyroxine were found to be significantly higher in the breast cancer group, even after adjusting for thyroid replacement therapy. The presence of thyroid antibodies did not differ significantly between the compared groups. In a subgroup analysis, breast cancer cases with thyroid disease and particularly hypothyroidism had a significantly lower incidence of lymph node metastases compared with breast cancer cases without thyroid disease. Conclusions Our data confirmed the proliferative effect of thyroid hormones on breast cells, which had previously been shown in vitro. Additionally, thyroid disease and particularly hypothyroid function appeared to be associated with a lower incidence of lymph node metastases. Further studies to determine the prognostic role of thyroid hormones in breast cancer are warranted.

A Prospective Study on Prevalence of Thyroid Disorders in Hepatitis C Virus Infected Patients in a Tertiary Care Teaching Hospital.

Background: Hepatitis C virus (HCV) infection has been associated with thyroid abnormalities. Therefore this study was conducted to determine the association of thyroid disorders with chronic hepatitis C virus infection in patients who are not getting any antiviral treatment. Methods: Sixty-five patients without pre-existing thyroid abnormality having positive Hepatitis C Virus (HCV) infection (confirmed on PCR) and not willing for getting anti-viral treatment (interferon) were included in our study. Blood samples from 65 patients were collected at base line, 04 months, 08 months and at 12 months. The level of thyroid stimulating hormone (TSH) and thyroid antibodies was measured in these samples. Results: Nine patients (13.84%) developed thyroid disorder during the study period. Female patients (66.66%) mostly affected than males (33.33%). Among n=9 affected cases, 66.66% developed hyperthyroidism, 22.22% developed hypothyroidism and 11.11% developed positive thyroid antibody. Conclusion: A close association of thyroid disorder and chronic HCV infection is noted in the study population.

Redução e/ou negativação dos anticorpos antitireoidianos com tratamento homeopático: série de casos / Reduced and/or negative anti-thyroid antibodies after homeopathic treatment: a case series

O presente artigo descreve uma série de 9 casos de pacientes, de sexo feminino, idade de 31 a 56 anos, com diagnóstico de tireoidite autoimune, cujos títulos de anticorpos antitireoidianos diminuíram ou negativaram depois de ratamento homeopático. Além disso, em alguns casos foi possível recuperar o equilíbrio funcional da glândula. O acompanhamento foi variável, de 30 dias até 18 anos.

The present article describes a series of 9 cases corresponding to female patients, age 31 to 56 old, diagnosed with autoimmune thyroiditis, who exhibited reduced or negative anti-thyroid antibodies after homeopathic treatment. In some cases, normal function of thyroid was additionally achieved. Follow-up was variable, from 30 days to 18 years.

Freqüência de hipotireoidismo em pacientes com distúrbio bipolar tratados com carbonato de lítio / Frequency of hypothyroidism in patients with bipolar disorder treated with lithium

O carbonato de lítio é um estabilizador do humor usado no tratamento de pacientes portadores de Transtorno Bipolar do Humor. A influência do carbonato de lítio no eixo Hipotálamo-Hipófise-Tireóide pode trazer conseqüências sérias aos usuários dessadroga, pois um dos seus efeitos colaterais é a inibição da função da tireóide com prevalência do Hipotireoidismo sintomático e Hipotireoidismo subclínico nos pacientes. Com o intuito de verificar a prevalência de hipotireoidismo em pacientes com Distúrbio Bipolartratado com carbonato de lítio, foram revisados prontuários de 62 pacientes adultos, que consultaram no Ambulatório de Distúrbio Bipolardo Hospital Universitário de Santa Maria entre janeiro de 1973 e julho de 2003. A amostra foi constituída por 23 homens e 31 mulheres sendo 8 excluídos por falta de dados ou apresentarem outro tipo de diagnóstico. Observamos que a prevalência do desenvolvimentodo hipotireoidismo foi maior entre as mulheres (41,9%) do que nos homens (21,7%) portanto, as mulheres foram mais susceptíveis ao desenvolvimento do hipotireoidismo do que os homens. A determinação dos hormônios da tireóide antes e durante o uso do carbonato de lítio é de fundamental importância no monitoramento das complicações causadas pelas alterações dos hormônios da tireóide.

Lithium is a mood stabilizer used to treat patients with bipolar mood disorder. The influence of lithium in the hypothalamus–pituitary–thyroid (HPT) axis can bring serious consequences to the users of this drug because one of its collateral effects is the inhibition of thyroid function with prevalence of symptomatic hypothyroidism and subclinical hypothyroidism in patients. Sixty-two chats of adult patients that consulted in the Ambulatory of Bipolar Disorders at University Hospital of Santa Maria were reviewed between January 1973 and July 2003 in order to verify the prevalence of hypothyroidism in patients with bipolar disorder treated with lithium. The sample had 23 men and 31 women. Eight patients were excluded because of the lack of data or because they have presented another type of diagnostic. We observed that the prevalence to develop hypothyroidism in patients using lithium was bigger in women (41,9%) than in men (21,7%). Therefore women were more susceptible to develop hypothyroidism than men. Thyroid hormones determination before and during lithium treatment is really important to the control of complications caused by thyroid hormones alterations.

Evaluation of Autoimmunity in Patients with Chronic Urticaria / 대한피부과학회지

BACKGROUND: Although urticaria is a common disorder that affects as many as 25% of all people at some time during their lives, its etiology is unknown in most of cases, especially in chronic urticaria. Recently, autoimmune diseases, especially thyroid disorders, are thought to be related to the occurrence of chronic urticaria. OBJECTIVE: We attempted to find the possible association of autoimmunity, especially thyroid autoimmunity, with the occurrence of chronic urticaria. METHODS: One hundred thirteen patients with chronic urticaria were examined for their past medical histories of asthma, allergic rhinitis, atopic dermatitis, thyroid disease, other autoimmune disorders and blood examination for CBC, HBsAg, C3, C4, anti-thyroid antibodies (anti-thyroglobulin and anti-microsomal), rheumatoid factor (RF), antinuclear antibody (ANA), cryoglobulin and autologous skin test. RESULTS: 1. The male and female ratio was 1:1.2 (male 52, female 61) and the highest incidence of age was in 21-50 years. Atopic diathesis was described in 21.2% (24 patients) and dermographism was found in 38.9% (44 patients). 2. Thyroid disorders were reported in 2 patients, but other autoimmune diseases were not present in the other patients. 3. Positivity to anti-thyroid antibodies was shown in 22.1% (25 patients), 18.6% (21 patients) to anti-thyroglobulin antibody, 12.4% (14 patients) to anti-microsomal antibody and 8.8% (10 patients) to both. Positivity to RF was 2.7% (3 patients) and to ANA was 0.9% (1 patient). 4. Positive result of autologous skin test was found in 27.4% (31 patients). 5. Increase of WBC count was in 9.7% (11 patients), of eosinophil count in 2.7% (3 patients) and E.S.R. was increased in 22.1% (25 patients). Positivity to HBsAg was in 1.8% (2 patients) and the result of C3/C4 in 37.2% (42 patients) was lower than the normal value. CONCLUSION: This study suggests that autoimmunity including thyroid autoimmunity could be related to the pathogenesis of chronic urticaria.