Depression bei Hashimoto-Enzephalopathie (original) (raw)

Zusammenfassung

Bei der mit einer Hashimoto-Thyreoiditis assoziierten Hashimoto-Enzephalopathie wurden bisher schlaganfallartige Symptome, Krampfanfälle, Myoklonien, Psychosen und progrediente kognitive Störungen beschrieben. Die Diagnose stützt sich auf den Nachweis von erhöhten Schilddrüsenautoantikörpern und EEG-Veränderungen sowie das Ansprechen der klinischen Symptomatik auf eine Behandlung mit Kortikosteroiden. Wir berichten über eine 74-jährige Patientin mit schwerer depressiver Episode, deren affektive Symptomatik sich unter jeweils 4-wöchiger Behandlung mit täglich 40 mg Citalopram bzw. 150 mg Venlafaxin nicht besserte. Ein wiederholt pathologischer EEG-Befund veranlasste uns zu einer weiteren diagnostischen Abklärung, bei der deutlich erhöhte Serumantikörper gegen Thyreoperoxidase (TPO-AK) sowie ältere postentzündliche Veränderungen in der Schilddrüsensonographie auffielen. Bei Vereinbarkeit der Befunde mit einer Hashimoto-Enzephalopathie begannen wir mit einer oralen Kortikosteroidbehandlung zusätzlich zur antidepressiven Medikation. Hierunter war die schwere depressive Symptomatik der Patientin innerhalb von 4 Wochen gänzlich rückläufig. Gleichzeitig kam es zu einer Normalisierung des EEG-Befundes und zu einem Abfall der TPO-Ak. Möglicherweise manifestiert sich eine Hashimoto-Enzephalopathie mit depressiven Störungen als eigene Verlaufsform oder Frühform. Sie sollte bei therapierefraktären affektiven Störungen mit der Option einer möglichen Kortikosteroidbehandlung in die differenzialdiagnostischen Überlegungen einbezogen werden.

Summary

Characteristic clinical findings of Hashimoto’s encephalopathy (HE) are stroke-like episodes, epileptic seizures, myoclonus, psychosis, and progressive cognitive impairment. Diagnosis of HE is supported by elevated antithyroid antibodies, an abnormal EEG, and by good response to steroids. We report on a 74-year-old female patient with a severe depressive episode who showed no treatment response to citalopram 40 mg/day and venlafaxine 150 mg/day. Diagnostic examination revealed an abnormal EEG, elevated thyroid peroxidase antibodies (TPO-Ab), and older postinflammatory changes in thyroidal sonography. We diagnosed a depression in HE and began treatment with prednisolone 70 mg/day with stepwise dose reduction, continuing treatment with venlafaxine 150 mg/day. Within 4 weeks of treatment, the severe depressive episode disappeared as well as abnormal EEG. In addition, serum values of TPO-Ab decreased. In HE, depressive symptoms can possibly be seen in a subgroup of patients or in the early course of the disease. Diagnosis of HE should be included in diagnostic procedures in cases of therapy-refractory depression because of a good response of HE to steroids.

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Authors and Affiliations

  1. Universitätsklinik für Psychiatrie und Psychotherapie Tübingen
    C. Laske, T. Leyhe, G. Buchkremer & H. Wormstall
  2. Universitätsklinik für Psychiatrie und Psychotherapie Tübingen, Osianderstraße 24, 72070, Tübingen
    C. Laske

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  1. C. Laske
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  2. T. Leyhe
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  3. G. Buchkremer
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  4. H. Wormstall
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Correspondence to C. Laske.

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Laske, C., Leyhe, T., Buchkremer, G. et al. Depression bei Hashimoto-Enzephalopathie .Nervenarzt 76, 617–622 (2005). https://doi.org/10.1007/s00115-004-1820-6

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