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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.


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