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Thyroiditis in an Adolescent with Chronic Hallucinations and Depression

CITATION:  Mahmud, F.H., Lteif, A.N., et al.  (2003).  Steroid-Responsive Encephalopathy Associated With Hashimoto's Thyroiditis in an Adolescent With Chronic Hallucinations and Depression: Case Report and Review.  Pediatrics, 112, 3

ABSTRACT:   We describe the case of a 14-year-old girl who presented with a 5-year history of hallucinations and depression. She had significantly elevated thyroperoxidase (TPO) antibody titers consistent with the diagnosis of Hashimoto's thyroiditis. A magnetic resonance imaging (MRI) scan of the brain showed white matter changes affecting the frontal lobe, and cerebral hypoperfusion deficits were observed on serial single-photon emission computed tomography (SPECT) scans. The patient had significant clinical improvement and showed resolution on neuroimaging after corticosteroid treatment. Steroid responsive encephalopathy associated with Hashimoto's thyroiditis (SREHT) is a more accurate description of the previously named "Hashimoto's encephalopathy." This is a condition with neuropsychiatric symptoms associated with high anti-thyroid antibody titers which shows marked improvement following corticosteroid treatment.

The medical evaluation of adolescents who present with psychiatric symptoms requires a full. clinical assessment to exclude organic disease. The list of potential etiologies in these patients can be long, particularly if presenting symptoms do not fall into recognized patterns. We present the case of an adolescent with recent disclosure of long-standing hallucinations and depression who was found to have elevated thyroid-stimulating hormone (TSH) and anti-thyroid antibody titers. This case reinforces the importance of evaluating thyroid function in pediatric patients who present with ill-defined neuro--psychiatric symptoms.

References

1. Rallison MK, Dobyns 13M, Keating IT, Kall JI?,'I'yler 1:11. Occurrence. and natural history of chronic lymphocytic thyroiditis in childhood. J Pedinh'. 1976;86:675-682

2. Leigh 11, Kramer Sl. The psychiatric manifestations of endocrine disorders. Ado Mimi Med. 1984;29:413-445

3. Asher R. Myxedema madness. 13M/. 1949;2:,555-562

4. Garrard P, I lodges JR, De Vrics Pl, ct al. I lashimoto's cnccphalopathy presenting as myxocdematous madness. J Ncurol Neurosur~ Psychiolry. 2000;68:102-103

5. I lall RCW. Psychiatric effects of thyroid hormone disturbance Psgr'hosomal ics. 1983;24:7-18

6. Brain L, Jcllinick 1:1 1, Ball K. I loshimoto's disease and cnccphalopathy. Lnncef. 1966;2:512-514

7. Shaw PJ, Walls "I'J, Newman PK, Cleland PG, Cartlidge MIFF. 1lashimoto's cnccphalopathy: a steroid-responsive disorder associated with high anti-thyroid antibody titers-report of 5 cases. Neurolo,y. 1991141(Suppl 1):228-233

8. Kothbaue'-Margrcitcr I, Struzencggcr M, K011101 J, I3ou111gartnc1. R, I less IOW. Cncephalopathy associated with Hashimoto thyroiditis diagnosis and treatment. J Ncurol. 1996;243:585-593

9. Vasconcellos P., Tina-Garza JP, Takoury P, I'eiichel GM. Pediatric manifestations of Ileshimoto's cnccphalopathy. Pcdiatr Ncurol. 1999;20: 394-398

10. Takahashi S, Mitamma R, ]toll Y, Suzuki N, Mono A. Ilashimoto cnccphalopathy: etiologic considerations. Pcdiatr Ncurol. 1994;11: 328-331

11. Maydell BV, Kopp M, Komorski GV, Jeugling PD, Korinthenbcrg R. Hashimoto cnccphalopathy-is it underdiagnosed in pediatric patients? Neuropcdialrics. 2002;33:86-89

12. Castillo IT, Broeve PP, Caselli RJ, et al. Steroid-responsive cnccphalopathy associated with thyroid n11toimnnuiity; clinical and laboratory findings. Ncmolo, iy. 2002;58(Suppl 3):A248

13. Sybesma CA, Pinxtrercn-Nogle' lV, Sinnige LGP, van Oostrom JCI 1, deVrieses TW. I Iashimoto cnccphalopathy in a 12 year old girl. V111 ) Peed is f r. 1999;158:876-868

14. Qucrol Pascual MR, Aguirre Sanchez JJ, Velicia Mate MR, Gahetc Jimenez C, Duran 1-Icrrera MC, Gonzalez Dorrego P. U11cephalitis de I Iashimoto: 1111 n11eva caso con remission esponlanea. Neurolo,tiia. 2000; 15:313-316

15. Waterberg N, Willis D, Pellock JM. lincephalopathy as the presenting symptom of I lashimoto's thyroiditis. / Child Ncurol. 2000;15:66-69

16. Shim MA, Apter L, Dicke'man S,'I'yano N, Gadoth N. lincephalopathy
in compensated Hashimoto's encephalopathy: a clinical expression of autoinumme cerebral vasculitis. Brain Dec. 1986;8:60-64

17. Byrne OC, Luberi SM, Madigan CA, King MD. Hashimoto's thyroiditis-a rare but treatable cause of encephalopathy in children. E,ur J Poediatr Neurol. 2000;4:279-282

18. Seipelt M, Lerr 1, Nau R, et al. I fashimoto's encephalitis as a differential diagnosis of Creutzfeldt-Jakob disease. I Neuurol Ncurosurg Psychiatry. 1999;66:172-176

19. Archambeaud F, Galinat S, Regouby Y, et al. Fncephalopathy de Hashimoto. Analyse de quatre observations. Rev Med Interne. 2001;22:653-659

20. Canton A, de Fabregas O, Tintore M, Mesa J, Codina A. Simo R. Bncephalopathy associated to autoimmune thyroid disease: a more appropriate term for an underestimated condition? J Neurol Sci. 2000; 176:65-69

21. Boers PM, Colebatch JG. Hashimoto's encephalopathy responding to plasm apheresis. J Neurol Neurosurg Psychiatry. 2001;70:132-135

22. Becker KL, Ferguson RH, McConahay WM. Connective tissue diseases and symptoms associated with Hashimoto's thyroiditis. N Engl I Med. 1963;268:277-280

23. Forchetti CM, Katsamakis G, Garron DC. Autoimmune thyroiditis and a rapidly progressive dementia: global hypoperfusion on SPECT scanning suggests a possible mechanism. Neurology. 1997;49:623-626

24. Gucuyener K, Serdaroglu A, Bideci A, et al. Tremor and myoclonus heralding Hashimoto's encephalopathy. I Pediatr Endocrinal Metal). 2000; 13:1137-1141

25. Balestri P, Grosso S, Garibaldi G. Alternating hemiptegia of childhood or Hashimoto's encephalopathy?J Neurol Neurosurg Psychintry.1999;66: 548-549