Depression in Hashimoto's encephalopathy. Successful treatment of a severe depressive episode with a glucocorticoid as an add-on therapy

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 re...

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Bibliographic Details
Published in:Nervenarzt 2005-05, Vol.76 (5), p.617-622
Main Authors: Laske, C, Leyhe, T, Buchkremer, G, Wormstall, H
Format: Article
Language:ger
Subjects:
Aged
Chemotherapy, Adjuvant
Cyclohexanols - administration & dosage
Depressive Disorder, Major - etiology
Depressive Disorder, Major - prevention & control
Drug Combinations
Female
Glucocorticoids - administration & dosage
Humans
Prednisolone - administration & dosage
Severity of Illness Index
Thyroiditis, Autoimmune - complications
Thyroiditis, Autoimmune - drug therapy
Treatment Outcome
Venlafaxine Hydrochloride
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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.
ISSN:0028-2804