En række artikler (på engelsk) om forbindelsen mellem sygdomme i thyreoidea og psykisk helbred. Det betyder ikke, at alle hypothyreose-syge er psykisk syge. Tværtimod, betyder det at mange "psykisk syge" er slet ikke psykisk syge, men lider af sygdomme i thyreoidea og når disse er velbehandlet/velreguleret - ja, så forsvinder de "psykiske" sygdomme igen.
Hypothyreose ofte fejldiagnosticeret som psykisk sygdom.
Abscract: Hypothyroidism can often be misdiagnosed as psychiatric illness. The hypothyroid patient may present with depression, an organic mental disorder, apathy and/or frank psychosis (usually with paranoid symptoms). Psychiatric manifestations of the endocrinopathy will abate with thyroid hormone replacement therapy, unless the disease state has been sufficiently prolonged to cause some irreversible brain damage. This irreversibility mandates prompt diagnosis and specific hormonal replacement therapy. Thus, thyroid function screening is recommended for patients presenting with depression, psychosis or organic mental disorder.
Maskeret "myxødem vanvid".
Abscract: Hypothyroidism can present a wide range of psychiatric manifestations, including personality disturbance, neurotic traits and psychotic features. Psychiatric treatment techniques without recognition and correction of the endocrine root of the mental disturbance will result in a failure of treatment. However, severe hypothyroidism can exist with a poverty of classical signs and symptoms such that both internist and psychiatrist may easily overlook endocrine dysfunction as a possible etiology of the mental disorder. A case of long-standing paranoid illness whose etiology was severe myxedema with such a poverty of signs and symptoms is presented. Failure to recognize the endocrinopathy may not only produce recovery difficulties but also psychiatric and endocrine repercussions if psychotropic medications are given in such masked cases. These problems are considered with particular reference to lithium, and screening criteria to avoid this problem are discussed.
Psykotiske manifestationer af hypothyreose.
Abscract: The case of a young woman is reported, who was treated one and a half years with psychopharmacologic agents and psychotherapy until hypothyroidism was diagnosed. Initially the psychopathology with prominent though disorders led to a tentative diagnosis of schizophrenia. Under administration of thyroid hormone the patient was free of psychiatric and somatic symptoms within 3 months. Problems of diagnosis, therapy and prognosis are discussed in relation of the literature.
Depression og angst ved Hashimoto's
Abscract: OBJECTIVE: To evaluate the association between mood and anxiety disorders in Hashimoto disease and Euthyroid Goitre in a case control study. METHODS: Cases included 19 subjects with Hashimoto disease in euthyroid phase, 19 subjects with euthyroid goitre, 2 control groups each of 76 subjects matched (4/1) according to age and sex drawn from the data base of a community based sample. Psychiatric diagnoses were formulated using the International Composite Diagnostic Interview Simplified, according to DSM-IV criteria. All subjects underwent a complete thyroid evaluation including physical examination, thyroid echography and measure of serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase autoantibodies (anti-TPO). RESULTS: Subjects with Hashimoto disease showed higher frequencies of lifetime Depressive Episode (OR = 6.6, C.L. 95% 1.2-25.7), Generalized Anxiety Disorders (OR = 4,9 Cl 95% 1.5-25.4) and Social Phobia (OR = 20.0, CL 95% 2.3-153.3) whilst no differences were found between subjects with goitre and controls. CONCLUSION: The study seems to confirm that risk for depressive disorders in subjects with thyroiditis is independent of the thyroid function detected by routine tests and indicates that not only mood but also anxiety disorders may be associated with Hashimoto disease.
Psykiske symptomer på endokrine sygdomme.
Abscract: Several important points should be considered regarding psychiatric symptoms in endocrine disorders. The presence of cognitive deficits in a patient presenting with anxiety, depression, or another apparently "functional" psychiatric complaint should raise the index of suspicion of organic etiology, with endocrine disorders high on the list. Psychiatric symptoms secondary to endocrine disturbance generally reverse, albeit slowly, with treatment of the primary hormonal abnormality. When significant disruption of cognitive functioning is evident, residual deficits may develop. Treatment with psychotropic agents for symptomatic relief of psychiatric complaints should be undertaken with great caution in patients with endocrine disorders.
Psykiske og kognitive aspekter af hypothyreose.
Abscract: BACKGROUND: Diffuse and initial changes of behaviour, mood and cognition in hypothyroidism represent diagnostic and therapeutic challenges. MATERIAL AND METHODS: We present four cases and discuss relevant literature. Patients were followed from time of diagnosis through the first 6-12 months of thyroxine treatment. Symptoms were identified using interviews, questionnaires and tests. RESULTS: The patients had reduced quality of life, depression, anxiety and impaired short time memory. All symptoms improved with thyroxine treatment, although patients did not necessarily reach premorbid functioning in 6-12 months. In the literature, depression in hypothyroidism is hypothesised to be at least partly caused by relative hypothyroidism in the central nervous system, and local brain triiodothyronine deficiency may be a possible explanation for affective and cognitive symptoms in subclinical hypothyroidism. INTERPRETATION: Physicians should actively address psychiatric and cognitive aspects of hypothyroidism and in addition to thyroxine offer supportive treatment, especially to those depressed.
Psykiatriske manifestationer som den eneste kliniske tegn på hypothyreose.
Abscract: This article intends to demonstrate, by presenting a clinical case, the importance of the thyroid examination in psychiatric practice. After a brief presentation of the evolution of the conceptions regarding the relation between thyroid insufficiency and psychiatric pathology, a clinical case is reported. This 63 years old man was admitted in a psychiatric ward because of his persecutive delusions and behavioral disorders (agitation, agressivity). Cognitive (namely memory) impairment was also present at the time of admission. The endocrine investigation has documented, in spite of the absence of any suggestive physical signs, a thyroid insufficiency. After the replacement treatment, all symptoms but the cognitive dysfunction disappeared. The patient's evolution is presented clinically, also rated on MMSE and MADRS scales, and biologically (TSH and T4 determination) for a 4 months period. The absence of any pathognomonical psychiatric finding, the possibility of the absence of other signs and symptoms (namely physical) in the hypothyroid state, the presence of potentially irreversible cognitive deterioration, as well as the inocuity and sensibility of thyroid hormones examination justify the systematic thyroid evaluation for all new psychiatric patients.
Ufrivillig strøm af meningsløse ord i patientens sind (hallucination of solioquy) ved Hashimoto`s betinget hypothyreose.
Abscract: We describe the first reported case of symptomatic psychosis with the 'hallucination of soliloquy.' A 48[correction of 40]-year-old woman with Hashimoto disease exhibited of compulsive checking, mysophobia, and excessive hand washing. When these obsessive-compulsive symptoms diminished, she began to suffer from the 'hallucination of soliloquy', the automatic flow of meaningless words inside her mind. As the 'soliloquy' increased, her mood became unstable and she attempted suicide by analgesic ingestion. After this, she was admitted to the psychiatric ward of a general hospital. The administration of clomipramine (150 mg daily) decreased the 'soliloquy' symptoms, but they did not resolve. When hypothyroidism became available, thyroid hormone treatment (levothyroxine at 50 mg daily) was started. Four weeks later, her 'soliloquy' symptoms had almost resolved and after three months in a stable state, thyroid hormone treatment was stopped and her 'soliloquy' symptoms soon reappeared. After thyroid hormone treatment was resumed, her 'soliloquy' symptoms disappeared immediately. Typical auditory hallucinations and delusions of reference were not observed throughout the clinical course. We speculate that the symptoms were symptomatic psychosis induced by hypothyroidism secondary to Hashimoto disease, because the changes of her hallucinations were related to free T3 values and the symptoms disappeared soon after starting thyroid hormone treatment. The main features of this case were 'soliloquy' alternating with obsessive-compulsive symptoms, but her 'soliloquy' symptoms were thought to be autochthonous ideas rather than obsessive thoughts. Furthermore, the symptoms in this case were different from schizophrenia, since there was no disturbance of communication, and she had the sensation of both speaking and hearing her own voice. The psychopathology of this 'hallucination of soliloquy' may be related to the theory of 'vocalization of background thinking' (N. Nakayasu). Detailed observation of patients with symptomatic psychosis and a psychopathological description of their symptoms may help to contribute to the etiologic elucidation and treatment of psychosis.
Depression som følge af en "symptomfri" autoimmun thyroiditis.
Abscract: The magnitude of the thyroid-stimulating hormone (TSH) response induced by thyrotropin-releasing hormone (TRH) helps identify patients whose thyroid is failing. Many of these patients have been found to have Hashimoto's thyroiditis, symptomless autoimmune thyroiditis (SAT), and subclinical hypothyroidism. While patients with SAT are clinically euthyroid, what might be "symptomless" for the endocrinologist might be a syndrome presenting with psychiatric symptoms to the psychiatrist. As a preliminary test of this hypothesis, we tested 100 consecutive admissions to a psychiatric hospital who complained of depression or lack of energy. Fifteen (15%) of 100 patients were identified from the baseline thyroxin (T4), triiodothyronine (T3) resin uptake (RU), T3 radioimmunoassay (T3RIA), TSH, and TRH test who met criteria for either subclinical, mild, or overt hypothyroidism. Of these 15 patients, 9 (60%) had positive thyroid microsomal antibodies with titers of greater than or equal to 1:10. Our data suggest that SAT is not symptomless and may be an important diagnosis to consider in the evaluation of depressed, anergic, or atypical patients.
Myxødematøs vanvid uden myxødem.
Abscract: A young woman, whose psychiatric history covered 16 years, has been treated several times as in-patient for psychotic depression, which were finally cured with thyroid replacement therapy. Recent reports of the connection between depression and disturbances in the hypothalamic-pituitary-thyroid axis are discussed. The authors question the suggestion that selective pituitary insufficiency and a defect in TSH release on TRF loading are rare phenomena.
Hypothyreose og depression: en terapeutisk udfordring.
Abscract: OBJECTIVE: To describe a patient with longstanding depression and hypothyroidism who had marked mood improvement only after triiodothyronine (T3) was added to her thyroxine (T4) replacement therapy. CASE SUMMARY: A 50-year-old white woman had a long history of depression and documented hypothyroidism since 1991. Despite treatment with T4 with dosages up to 0.3 mg/d, she continued to be depressed, have symptoms of hypothyroidism, and have a persistently elevated thyroid-stimulating hormone concentration. Addition of a low dose of T3 to her regimen resulted in significant mood improvement. DISCUSSION: The relationship between hypothyroidism and depression is well known. It is possible that this patient's long history of depression may have been a consequence of inadequately treated hypothyroidism, due either to poor patient compliance or resistance to T4. Nevertheless, her depression responded to addition of a low dose of T3 to her regimen. This case emphasizes the importance of screening depressed patients for hypothyroidism. Her clinical course also suggests that depression related to hypothyroidism may be more responsive to a regimen that includes T3 rather than to replacement with T4 alone. This is consistent with the observation that T3 is superior to T4 as adjuvant therapy in the treatment of unipolar depression. CONCLUSIONS: Depressed patients should be screened for hypothyroidism. In hypothyroid patients, depression may be more responsive to a replacement regimen that includes T3 rather than T4 alone. Therefore, inclusion of T3 in the treatment regimen may be warranted after adequate trial with T4 alone.
Psykotiske tilstande er forbundet med forstyrrelser i skjoldbruskkirtlens funktion.
Abscract: Thyroid-related psychoses continue to pose diagnostic and treatment challenges for clinicians. Two case histories illustrate diverse clinical states associated with hyper- and hypo-thyroidism respectively and highlight the need to consider the possibility of thyroid disorder in all patients presenting with acute psychotic mental disorder. They also demonstrate treatment methods directed at control of psychotic symptoms and restoration of an euthyroid state.
Det diagnostiske dilemma: myxødem og sindsyge, akse I og II.
Abscract: A patient with presumed chronic paranoid schizophrenia had chronic thyroiditis and Grade I hypothyroidism. Psychosis cleared following treatment with thyroid replacement. The probable presence of two axis II disorders may have contributed to the missed medical diagnosis and the patient's eventual suicide. The personality disorders were a major problem in the patient's medical and psychiatric care. The differential diagnosis among hypothyroidism and primary axis I psychotic and depressive psychopathology has always been problematic. When axis II pathology is also present, the diagnostic dilemma is increased.
Eeksplorativ undersøgelse af Thyreoideafunktion i kliniske undertyper af svær depression.
Abscract: BACKGROUND: Unipolar depression might be characterized by a 'low-thyroid function syndrome'. To our knowledge, this is the first study which explores the possible relationship of DSM-IV depressive subtypes and the medium term outcome, with thyroid function. METHODS: Material: Thirty major depressive patients (DSM-IV) aged 21-60 years and 60 control subjects were included. Clinical Diagnosis: The SCAN v 2.0 and the IPDE were used. The psychometric Assessment included HDRS the HAS and the GAF scales. Free-T3, Free-T4, TSH, Thyroid Binding Inhibitory Immunoglobulins (TBII), Thyroglobulin antibodies (TA) and Thyroid Microsomal Antibodies (TMA) were measured in the serum. The Statistical analysis included 1 and 2-way MANCOVA, discriminant function analysis and Pearson Product Moment Correlation Coefficient. RESULTS: All depressive subtypes had significantly higher TBII levels in comparison to controls. Atypical patients had significantly higher TMA in comparison to controls. No significant correlation was observed between the HDRS, HAS and GAF scales and thyroid indices. Discriminant function analysis produced functions based on thyroid indices, which could moderately discriminate between diagnostic groups, but could predict good response to treatment with 89.47% chance of success. CONCLUSION: Although overt thyroid dysfunction is not common in depression, there is evidence suggesting the presence of an autoimmune process affecting the thyroid gland in depressive patients.
Studier af thyreoidea terapi og thyreoideafunktion hos depressive patienter.
Abscract: A number of cases of depressed patients have latent hypothyroidism, possibly due to hypothalamo-pituitary dysfunction, and become refractory to antidepressant drugs. The dramatic effect or thyroid medication combined with tricyclic antidepressants is often observed in such persistently depressed patients. This effect seems to pertain to the catecholamine hypothesis of depression, but this requires further elucidation.
Erfaringer med træthed og depression før og efter lav-dosis 1-thyroxin tilskud hos patienter længe før euthyroid-tilstand kan påvises ved thyroid-panel.
Abscract: Hypothyroidism is a relative state, long associated with fatigue and depression. Individuals may experience thyroid-related symptoms such as fatigue and depression before thyroid indices become abnormal. However, because of clinicians' diverse interpretations of appropriate circumstances for its use, low-dose, 1-thyroxine supplementation often is overlooked as a therapeutic agent for symptom treatment. The purpose of this exploratory, hermeneutic study was to describe euthyroid individuals' experiences of fatigue and depression before and after low-dose 1-thyroxine supplementation. For women participants, the collective influence of fatigue and depression prior to treatment interfered significantly with their day-to-day lives, despite their euthyroid status. For men, the influence of symptoms was far less substantial than for women. In general, participants responded favorably, both physically and emotionally, to low-dose 1-thyroxine supplementation. Furthermore, no participant experienced 1-thyroxine induced hyperthyroidism or untoward side effects attributable to 1-thyroxine. Further study of effects of 1-thyroxine on symptoms is needed.
Tilstedeværelse af Thyroid antistoffer ved depressive lidelser.
Abscract: Whereas clinical relevant hypo- as well as hyperthyreosis are strongly suspected to induce psychiatric symptoms, there is a controversy about the relevance of only subclinical and autoimmune findings. We found autoantibodies (MAK, TAK, TRAK) in a high percentage (100 out of 144 = 70%) in severely depressed inpatients. Also we found a Hashimoto thyreoiditis in 5 patients. In the long run this may lead to relevant hypothyreosis which is regarded to be a risk factor for depression and for possible non-response in medical treatment. We conclude that in cases of repeated depressive episodes especially depression of the elderly and in nonresponders it seems necessary not only to get lab for TSH, T3 and T4 but also to assess the autoimmune status of the thyroid gland (autoantibodies). There is further need for controlled studies whether there is a better outcome in nonresponders to antidepressive medical treatment and positive autoantibody status after supplementation with triiodothyronine.
Tilstedeværelsen af antithyroid antistoffer hos patienter med affektive og nonaffective psykiatriske lidelser.
Abscract: We determined the frequency of antithyroglobulin and antimicrosomal antibodies in 173 consecutively admitted psychiatric inpatients. (We found antithyroid antibodies in 8% (5/65) of patients with DSM-III major depression, 13% (4/31) with biploar disorder, and in 0% (0/4) of those with schizoaffective disorder.) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole. The overall frequency of positive antithyroid antibody titers in patients with DSM-III affective disorder, 9% (9/99), did not differ from that in patients with nonaffective disorders, 10% (7/68 ). However, patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients. Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder, even in the absence of lithium exposure. However, as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders, the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation.
Antithyroid antistoffer hos deprimerede patienter.
Abscract: The presence of antithyroid (antimicrosomal and antithyroglobulin) antibodies was assessed in 45 psychiatric inpatients with prominent depressive symptoms (28 with DSM-III major depression). Nine patients (20%) had detectable titers of antithyroid antibodies, a rate considerably higher than the 5%-10% observed in the normal population. Each of these nine patients with symptomless autoimmune thyroiditis had normal baseline serum thyrotropin concentrations and normal thyroid function (as assessed by T4, T3 uptake, and free thyroxine index). These findings support the hypothesis of subtle thyroid dysfunction in a sizable sample of psychiatric inpatients with prominent depressive symptoms.
Abnormiteter i blodgennemstrømningen i hjernen hos patienter med euthyroid autoimmun thyreoiditis.
Abscract: PURPOSE: Brain perfusion abnormalities have recently been demonstrated by single-photon emission computed tomography (SPECT) in rare cases of severe Hashimoto's thyroiditis (HT) encephalopathy; moreover, some degree of subtle central nervous system (CNS) involvement has been hypothesised in HT, but no direct evidence has been provided so far. The aim of this study was to assess cortical brain perfusion in patients with euthyroid HT without any clinical evidence of CNS involvement by means of 99mTc-ECD brain SPECT. Sixteen adult patients with HT entered this study following informed consent. METHODS: The diagnosis was based on the coexistence of high titres of anti-thyroid auto-antibodies and diffuse hypoechogenicity of the thyroid on ultrasound in association with normal circulating thyroid hormone and TSH concentrations. Nine consecutive adult patients with non-toxic nodular goitre (NTNG) and ten healthy subjects matched for age and sex were included as control groups. All patients underwent 99mTc-ECD brain SPECT. Image assessment was both qualitative and semiquantitative. Semiquantitative analysis was performed by generation of four regions of interest (ROI) for each cerebral hemisphere--frontal, temporal, parietal and occipital--and one for each cerebellar hemisphere in order to evaluate cortical perfusion asymmetry. The Asymmetry Index (AI) was calculated to provide a measurement of both magnitude and direction of perfusion asymmetry. RESULTS: As assessed by visual examination, 99mTc-ECD cerebral distribution was irregular and patchy in HT patients, hypoperfusion being more frequently found in frontal lobes. AI revealed abnormalities in 12/16 HT patients, in three of the nine NTNG patients and in none of the normal controls. A significant difference in the mean AI was found between patients with HT and both patients with NTNG (p<0.003) and normal controls (p<0.001), when only frontal lobes were considered. CONCLUSION: These results show the high prevalence of brain perfusion abnormalities in euthyroid HT. These abnormalities are similar to those observed in cases of severe Hashimoto's encephalopathy and may suggest a higher than expected involvement of CNS in thyroid autoimmune disease.
Hjernens stofskifte ved hypothyreose undersøgt med 31P magnetisk resonans-spektroskopi.
Abscract: Metabolic consequences of hypothyroidism in adult human brain, despite neuropsychological symptoms, have not been reported. We used 31P nuclear magnetic-resonance spectroscopy of the frontal lobe to examine the effect of acute hypothyroidism on cerebral metabolism. Paired analysis showed that the phosphocreatine/inorganic-phosphate (PCr/Pi) ratio increased from a median of 2.04 (interquartile range 0.15) to 2.22 (0.25) after treatment with levothyroxine (p = 0.01). These reversible alterations in adult cerebral phosphate metabolism during acute hypothyroidism parallel PCr/Pi ratio changes described in skeletal muscle. This is the first direct evidence of cerebral metabolic effects of hypothyroidism on adult brain.
Subklinisk hypothyreose og prøvebehandling med Armour Thyroid
Abscract: Evidence is presented that many people have hypothyroidism undetected by conventional laboratory thyroid-function tests, and cases are reported to support the empirical use of Armour thyroid. Clinical evaluation can identify individuals with sub-laboratory hypothyroidism who are likely to benefit from thyroid-replacement therapy. In a significant proportion of cases, treatment with thyroid hormone has resulted in marked improvement in chronic symptoms that had failed to respond to a wide array of conventional and alternative treatments. In some cases, treatment with desiccated thyroid has produced better clinical results than levothyroxine. Research supporting the existence of sub-laboratory hypothyroidism is reviewed, and the author's clinical approach to the diagnosis and treatment of this condition is described.
Psychoneuroendokrinologi af affektive sindslidelser. Hypothalamus-hypofyse-thyroidea-aksen.
Abscract: Abnormal thyroid functioning can affect mood and influence the course of unipolar and bipolar disorder. Even mild thyroid dysfunction has been associated with changes in mood and cognitive functioning. Thyroid hormone supplementation may have role in the treatment of certain mood disorders, particularly rapid-cycling bipolar disorder. Women are more vulnerable to thyroid dysfunction than men and also respond better to thyroid augmentation. This article reviews the relationship between thyroid function and mood, and the use of thyroid hormones in the treatment of mood disorders. The impact of gender on these issues is also discussed.
Lokal cerebral blodgennemstrømning hos patienter med mild hypothyroidisme.
Abscract: Emotional and cognitive abnormalities are common in adult hypothyroidism. Few studies, however, have evaluated cerebral perfusion and metabolism in this disorder. The aims of this study were to compare regional cerebral blood flow (rCBF) between hypothyroid patients and healthy subjects and assess flow during the euthyroid state after treatment. METHODS: Ten mildly hypothyroid patients, before and after thyroxine treatment, and 10 healthy controls underwent 99mTc-hexamethylpropyleneamine oxime brain SPECT, MRI, and psychometric testing. SPECT images were analyzed using statistical parametric mapping. RESULTS: Compared with controls, rCBF in patients before treatment was lower in right parietooccipital gyri, cuneus, posterior cingulate, lingual gyrus, fusiform, insula, and pre- and postcentral gyri. Perfusion did not normalize on a return to the euthyroid state. CONCLUSION: Decreased rCBF in mild hypothyroidism is found in regions mediating attention, motor speed, memory, and visuospatial processing, faculties affected in hypothyroidism. Follow-up studies are needed to determine the longer-term persistence of perfusion abnormalities in this disorder.
Myxødem-psykose - sindssyge i gerningsøjeblikket
Abscract: In the course of a hypothyroid psychosis, a young man committed murder. He was later judged to be not guilty by reason of insanity, although he was clearly sane at the time of his trial. Diagnostic, treatment and longer range management problems are discussed.