Lithium‐induced Hashimoto’s encephalopathy: a case report
Objective: To report on a patient with Hashimoto’s encephalopathy induced by lithium. Patient and interventions: A 61‐year‐old woman with a type II bipolar disorder and a history of lithium‐induced thyrotoxicosis associated with silent thyroiditis was hospitalized to treat a severe major depressiv...
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| Veröffentlicht in: | Bipolar disorders 2008-11, Vol.10 (7), p.846-848 |
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| creator | Nagamine, Masanori Yoshino, Aihide Ishii, Motoyasu Ogawa, Tetsuo Kurauchi, Sachi Yoshida, Takeshi Shigemura, Jun Kodera, Tsutomu Tanaka, Yuji Nomura, Soichiro |
| description | Objective: To report on a patient with Hashimoto’s encephalopathy induced by lithium.
Patient and interventions: A 61‐year‐old woman with a type II bipolar disorder and a history of lithium‐induced thyrotoxicosis associated with silent thyroiditis was hospitalized to treat a severe major depressive episode. Given long‐term treatment with levothyroxine for hypothyroidism that had resulted from silent thyroiditis, endogenous hormone in thyroid follicles was assumed to be minimized by the negative feedback, decreasing risk of recurrent thyrotoxicosis if lithium were restarted.
Results: Lithium clearly relieved the patient’s depressive symptoms, but after 40 days encephalopathy developed. Thyrotoxicosis was ruled out, and serum antithyroid antibody titers were elevated. In the cerebrospinal fluid, protein content was substantially elevated and antithyroid antibodies were detected. Encephalopathy resolved dramatically after course of intravenous pulse therapy with methylprednisolone.
Conclusions: We believe that autoantibodies against antigens shared by the thyroid gland and the brain were induced by exposure to lithium, causing the patient to develop Hashimoto’s encephalopathy. |
| doi_str_mv | 10.1111/j.1399-5618.2008.00605.x |
| format | Article |
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Patient and interventions: A 61‐year‐old woman with a type II bipolar disorder and a history of lithium‐induced thyrotoxicosis associated with silent thyroiditis was hospitalized to treat a severe major depressive episode. Given long‐term treatment with levothyroxine for hypothyroidism that had resulted from silent thyroiditis, endogenous hormone in thyroid follicles was assumed to be minimized by the negative feedback, decreasing risk of recurrent thyrotoxicosis if lithium were restarted.
Results: Lithium clearly relieved the patient’s depressive symptoms, but after 40 days encephalopathy developed. Thyrotoxicosis was ruled out, and serum antithyroid antibody titers were elevated. In the cerebrospinal fluid, protein content was substantially elevated and antithyroid antibodies were detected. Encephalopathy resolved dramatically after course of intravenous pulse therapy with methylprednisolone.
Conclusions: We believe that autoantibodies against antigens shared by the thyroid gland and the brain were induced by exposure to lithium, causing the patient to develop Hashimoto’s encephalopathy.</description><identifier>ISSN: 1398-5647</identifier><identifier>EISSN: 1399-5618</identifier><identifier>DOI: 10.1111/j.1399-5618.2008.00605.x</identifier><identifier>PMID: 19032717</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Antimanic Agents - adverse effects ; autoimmune thyroiditis ; Bipolar Disorder - drug therapy ; encephalopathy ; Female ; Hashimoto Disease - chemically induced ; Hashimoto’s disease ; Humans ; lithium ; Lithium Chloride - adverse effects ; Middle Aged ; thyrotoxicosis</subject><ispartof>Bipolar disorders, 2008-11, Vol.10 (7), p.846-848</ispartof><rights>Copyright © Blackwell Munksgaard 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4475-8380aa8a6dee5f624786c40b528c93f593cd92c79d689c7ac26278a3e58fa3343</citedby><cites>FETCH-LOGICAL-c4475-8380aa8a6dee5f624786c40b528c93f593cd92c79d689c7ac26278a3e58fa3343</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-5618.2008.00605.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-5618.2008.00605.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19032717$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nagamine, Masanori</creatorcontrib><creatorcontrib>Yoshino, Aihide</creatorcontrib><creatorcontrib>Ishii, Motoyasu</creatorcontrib><creatorcontrib>Ogawa, Tetsuo</creatorcontrib><creatorcontrib>Kurauchi, Sachi</creatorcontrib><creatorcontrib>Yoshida, Takeshi</creatorcontrib><creatorcontrib>Shigemura, Jun</creatorcontrib><creatorcontrib>Kodera, Tsutomu</creatorcontrib><creatorcontrib>Tanaka, Yuji</creatorcontrib><creatorcontrib>Nomura, Soichiro</creatorcontrib><title>Lithium‐induced Hashimoto’s encephalopathy: a case report</title><title>Bipolar disorders</title><addtitle>Bipolar Disord</addtitle><description>Objective: To report on a patient with Hashimoto’s encephalopathy induced by lithium.
Patient and interventions: A 61‐year‐old woman with a type II bipolar disorder and a history of lithium‐induced thyrotoxicosis associated with silent thyroiditis was hospitalized to treat a severe major depressive episode. Given long‐term treatment with levothyroxine for hypothyroidism that had resulted from silent thyroiditis, endogenous hormone in thyroid follicles was assumed to be minimized by the negative feedback, decreasing risk of recurrent thyrotoxicosis if lithium were restarted.
Results: Lithium clearly relieved the patient’s depressive symptoms, but after 40 days encephalopathy developed. Thyrotoxicosis was ruled out, and serum antithyroid antibody titers were elevated. In the cerebrospinal fluid, protein content was substantially elevated and antithyroid antibodies were detected. Encephalopathy resolved dramatically after course of intravenous pulse therapy with methylprednisolone.
Conclusions: We believe that autoantibodies against antigens shared by the thyroid gland and the brain were induced by exposure to lithium, causing the patient to develop Hashimoto’s encephalopathy.</description><subject>Antimanic Agents - adverse effects</subject><subject>autoimmune thyroiditis</subject><subject>Bipolar Disorder - drug therapy</subject><subject>encephalopathy</subject><subject>Female</subject><subject>Hashimoto Disease - chemically induced</subject><subject>Hashimoto’s disease</subject><subject>Humans</subject><subject>lithium</subject><subject>Lithium Chloride - adverse effects</subject><subject>Middle Aged</subject><subject>thyrotoxicosis</subject><issn>1398-5647</issn><issn>1399-5618</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkM1Kw0AUhQdRbK2-gmTlLnH-f0QXWn9aKLjR9TCdTEhK0sRMgu2uj-DW1-uTmLRFt97NPXDPORc-AAIEI9TN9SJCRKmQcSQjDKGMIOSQRasjMPw9HO-07DQVA3Dm_QJCxDFkp2CAFCRYIDEEd7OsSbO22G6-smXcWhcHE-PTrCibcrv59oFbWlelJi8r06Trm8AE1ngX1K4q6-YcnCQm9-7isEfg_fnpbTwJZ68v0_H9LLSUChZKIqEx0vDYOZZwTIXklsI5w9IqkjBFbKywFSrmUllhLOZYSEMck4khhJIRuNr3VnX50Trf6CLz1uW5Wbqy9RopqqiUuDPKvdHWpfe1S3RVZ4Wp1xpB3aPTC90T0j0h3aPTO3R61UUvDz_aeeHiv-CBVWe43Rs-s9yt_12sHx6nnSA_QAZ93w</recordid><startdate>200811</startdate><enddate>200811</enddate><creator>Nagamine, Masanori</creator><creator>Yoshino, Aihide</creator><creator>Ishii, Motoyasu</creator><creator>Ogawa, Tetsuo</creator><creator>Kurauchi, Sachi</creator><creator>Yoshida, Takeshi</creator><creator>Shigemura, Jun</creator><creator>Kodera, Tsutomu</creator><creator>Tanaka, Yuji</creator><creator>Nomura, Soichiro</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope></search><sort><creationdate>200811</creationdate><title>Lithium‐induced Hashimoto’s encephalopathy: a case report</title><author>Nagamine, Masanori ; Yoshino, Aihide ; Ishii, Motoyasu ; Ogawa, Tetsuo ; Kurauchi, Sachi ; Yoshida, Takeshi ; Shigemura, Jun ; Kodera, Tsutomu ; Tanaka, Yuji ; Nomura, Soichiro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4475-8380aa8a6dee5f624786c40b528c93f593cd92c79d689c7ac26278a3e58fa3343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Antimanic Agents - adverse effects</topic><topic>autoimmune thyroiditis</topic><topic>Bipolar Disorder - drug therapy</topic><topic>encephalopathy</topic><topic>Female</topic><topic>Hashimoto Disease - chemically induced</topic><topic>Hashimoto’s disease</topic><topic>Humans</topic><topic>lithium</topic><topic>Lithium Chloride - adverse effects</topic><topic>Middle Aged</topic><topic>thyrotoxicosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nagamine, Masanori</creatorcontrib><creatorcontrib>Yoshino, Aihide</creatorcontrib><creatorcontrib>Ishii, Motoyasu</creatorcontrib><creatorcontrib>Ogawa, Tetsuo</creatorcontrib><creatorcontrib>Kurauchi, Sachi</creatorcontrib><creatorcontrib>Yoshida, Takeshi</creatorcontrib><creatorcontrib>Shigemura, Jun</creatorcontrib><creatorcontrib>Kodera, Tsutomu</creatorcontrib><creatorcontrib>Tanaka, Yuji</creatorcontrib><creatorcontrib>Nomura, Soichiro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><jtitle>Bipolar disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nagamine, Masanori</au><au>Yoshino, Aihide</au><au>Ishii, Motoyasu</au><au>Ogawa, Tetsuo</au><au>Kurauchi, Sachi</au><au>Yoshida, Takeshi</au><au>Shigemura, Jun</au><au>Kodera, Tsutomu</au><au>Tanaka, Yuji</au><au>Nomura, Soichiro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lithium‐induced Hashimoto’s encephalopathy: a case report</atitle><jtitle>Bipolar disorders</jtitle><addtitle>Bipolar Disord</addtitle><date>2008-11</date><risdate>2008</risdate><volume>10</volume><issue>7</issue><spage>846</spage><epage>848</epage><pages>846-848</pages><issn>1398-5647</issn><eissn>1399-5618</eissn><abstract>Objective: To report on a patient with Hashimoto’s encephalopathy induced by lithium.
Patient and interventions: A 61‐year‐old woman with a type II bipolar disorder and a history of lithium‐induced thyrotoxicosis associated with silent thyroiditis was hospitalized to treat a severe major depressive episode. Given long‐term treatment with levothyroxine for hypothyroidism that had resulted from silent thyroiditis, endogenous hormone in thyroid follicles was assumed to be minimized by the negative feedback, decreasing risk of recurrent thyrotoxicosis if lithium were restarted.
Results: Lithium clearly relieved the patient’s depressive symptoms, but after 40 days encephalopathy developed. Thyrotoxicosis was ruled out, and serum antithyroid antibody titers were elevated. In the cerebrospinal fluid, protein content was substantially elevated and antithyroid antibodies were detected. Encephalopathy resolved dramatically after course of intravenous pulse therapy with methylprednisolone.
Conclusions: We believe that autoantibodies against antigens shared by the thyroid gland and the brain were induced by exposure to lithium, causing the patient to develop Hashimoto’s encephalopathy.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19032717</pmid><doi>10.1111/j.1399-5618.2008.00605.x</doi><tpages>3</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Antimanic Agents - adverse effects autoimmune thyroiditis Bipolar Disorder - drug therapy encephalopathy Female Hashimoto Disease - chemically induced Hashimoto’s disease Humans lithium Lithium Chloride - adverse effects Middle Aged thyrotoxicosis |
| title | Lithium‐induced Hashimoto’s encephalopathy: a case report |
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