Depression in Hashimoto's encephalopathy. Successful treatment of a severe depressive episode with a glucocorticoid as ad on-therapy

被引：11
作者：
Laske C. [1 ,2 ]
Leyhe T. [1 ]
Buchkremer G. [1 ]
Wormstall H. [1 ]
机构：
[1] Universitätsklinik für Psychiatrie und Psychotherapie Tübingen, 72070 Tübingen
来源：
Der Nervenarzt | 2005年 / 76卷 / 5期
关键词：
Depression; Glucocorticoid therapy; Hashimoto's encephalopathy; Thyroid gland; TPO antibodies;
D O I：
10.1007/s00115-004-1820-6
中图分类号：
学科分类号：
摘要：
Characteristic clinical findings of Hashimoto's encephalopathy (HE) are stroke-like episodes, epileptic seizures, myoclonus, psychosis, and progressive cognitive impairment. Diagnosis of HE is supported by elevated antithyroid antibodies, an abnormal EEG, and by good response to steroids. We report on a 74-year-old female patient with a severe depressive episode who showed no treatment response to citalopram 40 mg/day and venlafaxine 150 mg/day. Diagnostic examination revealed an abnormal EEG, elevated thyroid peroxidase antibodies (TPO-Ab), and older postinflammatory changes in thyroidal sonography. We diagnosed a depression in HE and began treatment with prednisolone 70 mg/day with stepwise dose reduction, continuing treatment with venlafaxine 150 mg/day. Within 4 weeks of treatment, the severe depressive episode disappeared as well as abnormal EEG. In addition, serum values of TPO-Ab decreased. In HE, depressive symptoms can possibly be seen in a subgroup of patients or in the early course of the disease. Diagnosis of HE should be included in diagnostic procedures in cases of therapy-refractory depression because of a good response of HE to steroids. © Springer Medizin Verlag 2005.
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页码：617 / 622
页数：5
相关论文
共 24 条
[1]  
Chong J.Y., Rowland L.P., Utiger R.D., Hashimoto encephalopathy: Syndrome or myth?, Arch Neurol, 60, pp. 164-171, (2003)
[2]  
Hartmann M., Schaner B., Scheglmann K., Et al., Hashimoto-Enzephalopathie: Steroid-sensitive Enzephalopathie bei Hashimoto-Thyreoiditis, Nervenarzt, 71, pp. 489-494, (2000)
[3]  
Herbert T.B., Cohen S., Depression and immunity: A meta-analytic review, Psychol Bull, 113, pp. 472-486, (1993)
[4]  
Herold G., Et al., Innere Medizin, (2000)
[5]  
Jackson I.M., Does thyroid hormone have a role as adjunctive therapy in depression?, Thyroid, 6, pp. 63-67, (1996)
[6]  
Klein J.F., Adverse psychiatric effects of systemic glucocorticoid therapy, Am Fam Physician, 46, pp. 1469-1474, (1992)
[7]  
Konig F., Von Hippel C., Petersdorff T., Et al., Thyroid autoantibodies in depressive disorders, Acta Med Austriaca, 26, pp. 126-128, (1999)
[8]  
Kothbauer-Margreiter I., Sturzenegger M., Komor J., Et al., Encephalopathy associated with Hashimoto thyroiditis: Diagnosis and treatment, J Neurol, 243, pp. 585-593, (1996)
[9]  
Kuijpens J.L., Vader H.L., Drexhage H.A., Et al., Thyroid peroxidase antibodies during gestation are a marker for subsequent depression postpartum, Eur J Endocrinol, 145, pp. 579-584, (2001)
[10]  
Leonard B.E., Changes in the immune system in depression and dementia: Causal or co-incidental effects?, Int J Dev Neurosci, 19, pp. 305-312, (2001)
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