Case report

Affective psychosis, Hashimoto's thyroiditis, and brain perfusion abnormalities: case report

Alberto Bocchetta¹, Giorgio Tamburini², Pina Cavolina³, Alessandra Serra⁴, Andrea Loviselli⁵ and Mario Piga⁴

¹Sezione di Farmacologia Clinica, Dipartimento di Neuroscienze Bernard B Brodie, Università di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, via Ospedale 46, 09124 Cagliari, Italy

²Sezione di Neurologia, Dipartimento di Scienze Cardiovascolari e Neurologiche, Università di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, via Ospedale 46, 09124 Cagliari, Italy

³Sezione di Neuropsichiatria Infantile Dipartimento di Neuroscienze Bernard B Brodie, Università di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, via Ospedale 119, 09124 Cagliari, Italy

⁴Medicina Nucleare, Dipartimento di Scienze Mediche Internistiche Mario Aresu, Università di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, S.P. Monserrato-Sestu, 09042 Monserrato, Cagliari, Italy

⁵Endocrinologia, Dipartimento di Scienze Mediche Internistiche Mario Aresu, Università di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, S.P. Monserrato-Sestu, 09042 Monserrato, Cagliari, Italy

Clinical Practice and Epidemiology in Mental Health 2007, 3:31doi:10.1186/1745-0179-3-31

Published:	20 December 2007

Abstract

Background

It has recently become evident that circulating thyroid antibodies are found in excess among patients suffering from mood disorders. Moreover, a manic episode associated with Hashimoto's thyroiditis has recently been reported as the first case of bipolar disorder due to Hashimoto's encephalopathy. We report a case in which Hashimoto's thyroiditis was suspected to be involved in the deteriorating course of mood disorder and discuss potential pathogenic mechanisms linking thyroid autoimmunity with psychopathology.

Case presentation

A 43-year-old woman, with a history of recurrent depression since the age of 31, developed manic, psychotic, and soft neurological symptoms across the last three years in concomitance with her first diagnosis of Hashimoto's thyroiditis. The patient underwent a thorough medical and neurological workup. Circulating thyroperoxidase antibodies were highly elevated but thyroid function was adequately maintained with L-thyroxine substitution. EEG was normal and no other signs of current CNS inflammation were evidenced. However, brain magnetic resonance imaging evidenced several non-active lesions in the white matter from both hemispheres, suggestive of a non-specific past vasculitis. Brain single-photon emission computed tomography showed cortical perfusion asymmetry particularly between frontal lobes.

Conclusion

We hypothesize that abnormalities in cortical perfusion might represent a pathogenic link between thyroid autoimmunity and mood disorders, and that the rare cases of severe Hashimoto's encephalopathy presenting with mood disorder might be only the tip of an iceberg.