Stress-induced hashitoxicosis: case report and relative HLA serotype and genotype

SUMMARY OBJECTIVE Even though stress has been long known as a provocative factor for Graves' disease, its relationship with Hashimoto's thyroiditis is more controversial. Studies on this topic are scanty. This paper aims to report a case of stress-induced Hashitoxicosis. RESULTS Here we report a case of Hashitoxicosis induced by a psychological stressful event in a 28-year-old woman with Hashimoto's thyroiditis. She had remained stably euthyroid for 12 years. She was first observed in April 2016, while euthyroid. She came back after 11 months because of fatigue and palpitations, in the absence of neck pain. Thyroid function tests revealed moderate thyrotoxicosis (undetectable TSH; FT4 36.94 pmol/L, normal values 9.0-24.46; FT3 13.50 pmol/L, normal values 3.07-6.14) with negative TSH-receptor antibodies. In the previous three months, she had experienced a psychological stressful event. Inflammatory markers were negative, and the white cell count was normal. Thyroid ultrasound revealed a modest increase in vascularization. Transient subclinical hypothyroidism ensued after seven weeks and spontaneously recovered. On the last visit, the patient was still on euthyroidism. (TSH 1.01 mU/L; FT4 9.22 pmol/L; FT3 3.98 pmol/L). We also performed HLA serotyping and genotyping. CONCLUSION This case demonstrates that, similarly to Graves' disease, Hashitoxicosis can also be triggered by stressful life events.

RESUMO OBJETIVO Mesmo que o estresse seja conhecido há muito tempo como um fator provocativo para a doença de Graves, sua relação com a tireoidite de Hashimoto é mais controversa. Estudos sobre esse tema são escassos. O objetivo deste artigo é relatar um caso de Hashitoxicose induzida por estresse. RESULTADOS Aqui nós relatamos um caso de Hashitoxicose induzido por um evento psicológico estressante em uma mulher de 28 anos com tireoidite de Hashimoto. Ela permaneceu estável eutireoidiana por 12 anos. Ela veio a nossa observação pela primeira vez em abril de 2016, enquanto eutireoidiana. Voltou após 11 meses por causa de fadiga e palpitações, na ausência de dor no pescoço. Testes de função tireoidiana revelaram uma tireotoxicose moderada (TSH indetectável; T4F 36,94 pmol/L, valores normais 9,0-24,46; FT3 13,50 pmol/L, valores normais 3,07-6,14) com anticorpos negativos para o receptor de TSH. Nos últimos três meses ela experimentou um evento psicológico estressante. Os marcadores inflamatórios foram negativos e a contagem de leucócitos foi normal. A ultrassonografia da tireoide revelou um aumento modesto da vascularização. Hipotireoidismo subclínico transitório ocorreu após sete semanas e se recuperou espontaneamente. Na última visita, a paciente ainda estava em eutireoidismo. (TSH 1,01 mU/L; FT4 9,22 pmol/L; FT3 3,98 pmol/L). Também realizamos a sorotipagem e a genotipização do HLA. CONCLUSÃO Este caso demonstra que, similarmente à doença de Graves, também a Hashitoxicose pode ser desencadeada por eventos estressantes da vida.

Calidad de vida en pacientes con hipotiroidismo / Quality of life in patients with Hypothyroidism

Introduction: Patients with hypothyroidism may have worse quality of life, specially in Hashimoto's Thyroiditis (HT). Objective: Describe differences in the quality of life in patients with HT, compared to other causes of hypothyroidism in ambulatory patients. Method: Cross sectional, observational and descriptive study. The survey SF36 was applied, with prior authorization, to hypothyroid outpatients over 18 years without psychiatric, physical or mental disorder, dividing the sample into two groups: patients with TH and other causes of hypothyroidism. We used QualityMetric Health OutcomesTM Scoring Software 5.0, that gives a descriptive analysis of each area included in the instrument. Results: 53 patients, of whom 30 where diagnosed with TH, and 23 with other causes of hypothyroidism were surveyed. The characteristics were similar in both groups. The total group of hypothyroid patients had mental component under the average. In the specific analysis of the groups, the physical component was within the average general population. The mental component, was decreased in patients with other causes of hypothyroidism, but not in patients with TH. Conclusion: Comparing both groups, there were no differences in the physical component of patients with hypothyroidism. The mental component of the total group of hypothyroid patients compared to the general population was below average, especially in patients with other causes of hypothyroidism. The reason is unclear, but could be related to the absence of endogenous thyroid hormones

Esquizofrenia y tiroiditis de Hashimoto: descripción de un caso clínico / Schizophrenia and Hashimoto’s thyroiditis: a clinical case

Se muestra la asociación entre trastornos psiquiátricos y disfunción tiroídea, mediante el estudio de un adolescente con esquizofrenia y tiroiditis de Hashimoto. Se trata de un varón de 15 años de edad, con bajo rendimiento escolar y desinterés por actividades sociales y académicas. Inicialmente cumple criterios DSM IV para trastorno depresivo y se inicia tratamiento antidepresivo. El cuadro empeora apareciendo sintomatología psicótica donde prima el empobrecimiento afectivo y social, presencia de un juicio de realidad alterado y conducta escindida y autista. Se indica Risperidona lo que tiene un efecto moderado sobre la sintomatología, por lo que se agrega Aripiprazol. Las pruebas tiroídeas inicialmente fueron normales, sin embargo la evaluación endocrinológica confirma una Tiroiditis de Hashimoto iniciándose tratamiento con tiroxina (T4). Posteriormente la sintomatología remite. Queda la duda del papel jugado por la disfunción tiroídea en este caso y se destaca la necesidad de una evaluación cuidadosa de la tiroides en pacientes psiquiátricos.

The following work intends to show the association between psychiatric disorders and thyroid dysfunction through a study of a teenager with schizophrenia disorder and Hashimoto thyroiditis. We present the case of a young male, fifteen years of age, with complaints of low performance at school, and loss of interest in social activities and academic affairs. At the beginning, the symptoms observed in the patient coincided with the DSM-IV criteria for Depression, and treatment with antidepressants was begun. However, the illness soon worsened, with the appearance of different psychotic symptoms, with diminished social interactions and affects, and also the presence of an altered judgment as well as an autistic and split behavior. Risperidone is then indicated having moderate effect on symptoms, so Aripiprazol was added to the treatment. Initially, thyroid tests were normal, but further endocrine evaluation confirms Hashimoto´s thyroiditis diagnosis, indicating thyroxine (T4) treatment, after which the symptoms subside. There remains the question of the role of thyroid dysfunction in this particular case and the necessity to a careful thyroid evaluation in psychotic patients.