Psychotic depression due to Hashimoto thyroiditis

Baziki S, Yalcin M, Bestepe EE

Psychotic depression due to Hashimoto thyroiditis

Endocrine system disorders, especially thyroid disorders may cause a large number of psychiatric symptoms and aggravate existing ones. Thyroid disorders, particularly hypothyroidism are associated with depressive symptoms and cognitive problems, and rarely other psychotic complaints. A 54-year-old, married woman was admitted to psychiatric emergency service with significantly reduced speech, suspiciousness, decreased self-care, fear of being poisoned. She was displaying aggressive behaviors. Her family reported introversion, decreased sleep and appetite for three months with a slow progression. She was in depressed mood with an anxious affect and persecutory delusions and showing a negativist attitude towards the interviewer. There was noticeable decrease in her psychomotor activity. In her personal history, patient was diagnosed as having Hashimoto hypothyroidisms four years ago and was under treatment, which patient did not remember the name of anti-hypothyroidism drug, until two months ago. In the physical examination; her fever was 38.1 degrees celcius, in the complete blood count leukocytosis was detected. In the neurologic examination, only pathologic finding was Babinski reşexes were bilaterally extensor. Upon prediagnosis of encephalitis, prophylactic ceftriaxone 2 gr/day treatment was applied for seven days. In further investigation, computed tomography, the cranial magnetic resonance imaging, electroencephalogram and lumbar puncture were performed and no significant pathology was found. Thus, she had been admitted to psychiatric service. In the laboratory examination, TSH was measured as 85 mIU/ml and anti-TPO was 102.7mIU/ml. After internal medicine consultation, levothyroxine 200 microgram was started. Olanzapine20 mg, venlafaxine 75 mg was started for psychiatric treatment. Electroconvulsive therapy was applied because of food rejection due to her persecutory delusions about getting poisoned, and nine sessions performed. Her delusions disappeared in 10 days, then her depressive mood improved in 3 weeks. TSH decreased to 5.8 mIU/ml Anti-TPO was decreased to 25.8 mIU/ml. Hypothyroidism may cause depressive and psychotic symptoms and deficits in cognitive functions. Due to advanced age of patient, with no family history, development of the symptoms in a slow progression and concurrence with discontinued hypothyroidism treatment, the patient’s state is concluded to be associated with hypothyroidism. In the literature, psychotic features in depression associated with hypothyroidism due to Hashimoto thyroiditis, have not been reported frequently or this reason we wanted to present you our experience.