This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (15)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mahmud, F. H.
Right arrow Articles by Brands, C. K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mahmud, F. H.
Right arrow Articles by Brands, C. K.
Related Collections
Right arrow Endocrinology
PEDIATRICS Vol. 112 No. 3 September 2003, pp. 686-690

EXPERIENCE AND REASON

Steroid-Responsive Encephalopathy Associated With Hashimoto’s Thyroiditis in an Adolescent With Chronic Hallucinations and Depression: Case Report and Review

Farid H. Mahmud, MD and Aida N. Lteif, MD

Division of Pediatric Endocrinology and Metabolism
Department of Pediatric and Adolescent Medicine
Mayo Clinic
Rochester, MN 55905

Deborah L. Renaud, MD

Division of Child and Adolescent Neurology
Department of Pediatrics and Neurology
Mayo Clinic
Rochester, MN 55905

Ann M. Reed, MD

Division of Rheumatology
Department of Pediatrics and Medicine
Mayo Clinic
Rochester, MN 55905

Chad K. Brands, MD

Division of Community Pediatric and Adolescent Medicine
Department of Pediatric and Adolescent Medicine
Mayo Clinic
Rochester, MN 55905

Abbreviations: MRI, magnetic resonance imaging • SPECT, single-photon emission computed tomography • TSH, thyroid-stimulating hormone • EEG, electroencephalogram background activity • TPO, thyroperoxidase • CSF, cerebrospinal fluid • SREHT, steroid responsive encephalopathy associated with Hashimoto’s thyroiditis

The first 300 words of the full text of this article appear below.

We describe the case of a 14-year-old girl who presented with a 5-year history of hallucinations and depression. She had significantly elevated thyroperoxidase (TPO) antibody titers consistent with the diagnosis of Hashimoto’s thyroiditis. A magnetic resonance imaging (MRI) scan of the brain showed white matter changes affecting the frontal lobe, and cerebral hypoperfusion deficits were observed on serial single-photon emission computed tomography (SPECT) scans. The patient had significant clinical improvement and showed resolution on neuroimaging after corticosteroid treatment. Steroid responsive encephalopathy associated with Hashimoto’s thyroiditis (SREHT) is a more accurate description of the previously named "Hashimoto’s encephalopathy." This is a condition with neuropsychiatric symptoms associated with high anti-thyroid antibody titers which shows marked improvement following corticosteroid treatment.

The medical evaluation of adolescents who present with psychiatric symptoms requires a full clinical assessment to exclude organic disease. The list of potential etiologies in these patients can be long, particularly if presenting symptoms do not fall into recognized patterns. We present the case of an adolescent with recent disclosure of long-standing hallucinations and depression who was found to have elevated thyroid-stimulating hormone (TSH) and anti-thyroid antibody titers. This case reinforces the importance of evaluating thyroid function in pediatric patients who present with ill-defined neuropsychiatric symptoms.


   CASE REPORT
 
The patient is a 14-year-old girl with no significant past medical history who described visual and auditory hallucinations beginning at age 9. Her visual hallucinations comprised seeing animals and unknown people on walls often engaged in violent acts and she began hearing commanding and denigrating voices. Her symptoms caused significant distress associated with decreased mood and energy.

After normal electroencephalogram background activity (EEG), the patient was treated with numerous psychotropic medications over a 6-month period by her psychiatrist including valproic acid, sertraline, and quetiapine fumarate. These medications reduced the intensity, but not the frequency, of her hallucinations . . . [Full Text of this Article]

Address correspondence to Farid H. Mahmud, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: mahmud.farid@mayo.edu




This article has been cited by other articles:


Home page
 Arch NeurolHome page
P. Castillo, B. Woodruff, R. Caselli, S. Vernino, C. Lucchinetti, J. Swanson, J. Noseworthy, A. Aksamit, J. Carter, J. Sirven, et al.
Steroid-Responsive Encephalopathy Associated With Autoimmune Thyroiditis
Arch Neurol, February 1, 2006; 63(2): 197 - 202.
[Abstract] [Full Text] [PDF]

Home page
 J Child NeurolHome page
N. Watemberg, D. Greenstein, and A. Levine
Topical Review: Encephalopathy Associated With Hashimoto Thyroiditis: Pediatric Perspective
J Child Neurol, January 1, 2006; 21(1): 1 - 5.
[Abstract] [PDF]

Home page
 J. Neurol. Neurosurg. PsychiatryHome page
S Jacob and Y A Rajabally
Hashimoto's encephalopathy: steroid resistance and response to intravenous immunoglobulins
J. Neurol. Neurosurg. Psychiatry, March 1, 2005; 76(3): 455 - 456.
[Full Text] [PDF]

Home page
 NeurologyHome page
N. S. Hussain, J. Rumbaugh, D. Kerr, A. Nath, and A. E. Hillis
Effects of prednisone and plasma exchange on cognitive impairment in Hashimoto encephalopathy
Neurology, January 11, 2005; 64(1): 165 - 166.
[Full Text] [PDF]