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Lithium‐induced Hashimoto’s encephalopathy: a case report
Author(s) -
Nagamine Masanori,
Yoshino Aihide,
Ishii Motoyasu,
Ogawa Tetsuo,
Kurauchi Sachi,
Yoshida Takeshi,
Shigemura Jun,
Kodera Tsutomu,
Tanaka Yuji,
Nomura Soichiro
Publication year - 2008
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/j.1399-5618.2008.00605.x
Subject(s) - encephalopathy , levothyroxine , medicine , thyroiditis , lithium (medication) , hashimoto's disease , gastroenterology , bipolar disorder , anti thyroid autoantibodies , thyroid , endocrinology , pediatrics , autoantibody , immunology , antibody
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.