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Depression Can Confuse Diagnosis of Hashimoto's Encephalopathy
A DGReview of :"Depression, antithyroid antibodies and Hashimoto's encephalopathy"
L' Encephale
07/18/2001
By Elda Hauschildt
Psychiatric assessment for depression should be systematically added to clinical and biological work-ups for patients who suspected of having Hashimoto's encephalopathy.
French researchers say that diagnosis of the disease can be seriously delayed when patients are treated separately by different specialists.
"Diagnosis can be seriously delayed by the fact that the different symptoms implicate approaches by psychiatrists, neurologists or endocrinologists," they note.
"A psychiatric report should systematically be added to the clinical and biological findings in order to allow a better approach to the existing links between depression and other manifestations of the disease."
Investigators point out that psychiatric manifestations are infrequent or rarely described in Hashimoto's encephalopathy.
They say the disease usually begins as a sub-acute encephalopathy. Symptoms include confusion, tremor and other neurological signs. Relapse is characteristic of the disease.
"Neither biologic nor clinical symptoms are specific, but anti-thyroid antibody levels are characteristic."
Researchers report on the case history of a woman patient who first presented with symptoms of depression. She progressed to dementia with psychotic episodes, confusion and seizures before diagnosis of Hashimoto's encephalopathy.
Early steroid treatment made her symptoms regress. She was admitted to different neurologic and psychiatric departments before being correctly diagnosed.
"Each time the antidepressive treatment was stopped, depression relapsed in spite of appropriate steroid treatment," they add.
Investigators comment that the literature indicates there is a close link between depression and anti-thyroid antibodies. In Hashimoto's encephalopathy, this link continues after adjustments are made for the psychosocial determinants of depression.
Decreases in the antibodies reflect the decrease in inflammation.
"So for the psychiatrist, it is important to diagnose Hashimoto's encephalopathy without delay, especially when psychiatric manifestations are in the foreground," they conclude.
L'Encephale, 2001; 27: 137-142.
"Depression, antithyroid antibodies and Hashimoto's encephalopathy"
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