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.

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.

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.