Abstract
Mood disorders and circulating thyroid antibodies are very prevalent in the population and their concomitant occurrence may be due to chance. However, thyroid antibodies have been repeatedly hypothesized to play a role in specific forms of mood disorders. Potentially related forms include treatment-refractory cases, severe or atypical depression, and depression at specific phases of a woman’s life (early gestation, postpartum depression, perimenopausal). With regard to bipolar disorder, studies of specific subgroups (rapid cycling, mixed, or depressive bipolar) have reported associations with thyroid antibodies. Offspring of bipolar subjects were found more vulnerable to develop thyroid antibodies independently from the vulnerability to develop psychiatric disorders. A twin study suggested thyroid antibodies among possible endophenotypes for bipolar disorder. Severe encephalopathies have been reported in association with Hashimoto’s thyroiditis. Cases with pure psychiatric presentation are being reported, the antithyroid antibodies being probably markers of some other autoimmune disorders affecting the brain. Vasculitis resulting in abnormalities in cortical perfusion is one of the possible mechanisms.
Highlights
Mood disorders and circulating thyroid antibodies are very prevalent in the population and their concomitant occurrence may be due to chance
In a prospective account of the Sardinian lithium cohort study, we reported the appearance of circulating thyroid antibodies in young subjects of both sexes within a few years of lithium exposure (Bocchetta et al 1992)
Sample size was generally limited and cut-off for antibody positivity was rather low (1:10). Such low titers have been associated with the development of thyroiditis in prospective community studies (Tunbridge et al 1981), but they are very prevalent in the general population and their concomitant occurrence with other common conditions may be obviously due to chance
Summary
Echopattern consistent with Good response to lithium thyroiditis (not otherwise (age 37–54) specified). Case # 3 The patient had suffered from a first psychotic episode characterized by auditory hallucinations and persecutory delusions at the age of 23 Her symptoms subsided with haloperidol, but she manifested extrapyramidal side effects. Over the following 18 years, the patient has been maintained with clozapine (100–150 mg/die), augmented with small doses of haloperidol to counteract the occasional reemergence of auditory hallucinations She has continued l-thyroxine substitution and thyroid hormones have been within the normal range, but AbTPO remained elevated (>1000 IU/ml; normal range 0–20 IU/ml). Case # 5 The patient had started lithium therapy at the age of 57 and response was excellent She was referred to our thyroid hormone concentrations without any other endocrinological treatment. Case # 9 After the diagnosis of autoimmune thyroiditis at age 37, AbTPO titers remained elevated over the following 17 years, reaching the highest titer of 862 IU/ml (normal range 0–20 IU/ml). Given the presence of recurrent suicide ideation, lithium was eventually combined with valproate at the age of 58 with good response over the last 3 years
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