Thyroid Disease as a Cause of Psychosis: Hashimoto's Encephalopathy

Summary

This presentation explores Hashimoto's Encephalopathy, an autoimmune condition linked to Hashimoto's thyroiditis, which can manifest with psychiatric symptoms resembling psychosis. Highlighting its historical background, symptoms, and diagnostic challenges, it emphasizes the importance of recognizing autoimmune thyroid disorders in psychiatric patients. The discussion includes the pathophysiology connecting thyroid antibodies to neuropsychiatric changes, treatment options like glucocorticoids, and the complexities of screening for thyroid-related antibodies. Overall, it underscores the need for awareness and further research in understanding and managing this rare condition.

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Q & A

What is Hashimoto's Encephalopathy?

Hashimoto's Encephalopathy is a rare neurological condition linked to Hashimoto's thyroiditis, characterized by psychiatric symptoms such as psychosis and neurological disturbances.

How does Hashimoto's Encephalopathy relate to psychosis?

HE can present with symptoms resembling psychosis, leading to confusion with schizophrenia. These psychiatric symptoms may occur even when thyroid hormone levels are normal.

Who was Dr. Hashimoto, and what is his significance?

Dr. Hashimoto was a Japanese physician who, in 1912, described autoimmune thyroiditis, which later became associated with his name. His work laid the foundation for understanding Hashimoto's diseases.

What are the common symptoms of Hashimoto's Encephalopathy?

Symptoms typically include psychiatric changes (like psychosis), cognitive disruptions, seizures, ataxia, and possibly neurological signs, often occurring together.

How is Hashimoto's Encephalopathy diagnosed?

Diagnosis is primarily based on the presence of antibodies against thyroid peroxidase (TPO) and the occurrence of significant mental status changes. EEG abnormalities may also be observed.

What is the role of thyroid antibodies in Hashimoto's Encephalopathy?

Thyroid antibodies, particularly against TPO, are key indicators of Hashimoto's Encephalopathy. Their presence supports the diagnosis, although they can also be found in healthy individuals.

What treatments are available for Hashimoto's Encephalopathy?

The primary treatment involves glucocorticoids (such as prednisone), which are effective in managing symptoms. Other immune-modulating treatments and maintaining normal thyroid hormone levels are also important.

What is the estimated prevalence of Hashimoto's Encephalopathy?

HE is estimated to be rare, with about two cases per 100,000 people. However, studies indicate higher prevalence rates of thyroid antibodies in individuals with psychiatric conditions.

Should thyroid peroxidase antibodies be routinely screened in psychiatric patients?

There is debate regarding routine screening for TPO antibodies in psychiatric patients, as while high levels may indicate autoimmune disease, false positives can complicate diagnosis.

What are the implications of finding thyroid antibodies in patients with schizophrenia?

Finding thyroid antibodies in patients with schizophrenia may indicate a higher risk for severe symptoms, greater functional impairment, or a potential underlying autoimmune process that could be treated.