Hashimoto encephalopathy

2013 ◽  
Vol 154 (33) ◽  
pp. 1312-1316 ◽  
Author(s):  
Gábor Pocsay ◽  
Andrea Gazdag ◽  
József Engelhardt ◽  
István Szaniszló ◽  
Zoltán Szolnoki ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Immunosuppressive Treatment ◽  
Unknown Origin ◽  
Corticosteroid Treatment ◽  
Thyroid Peroxidase ◽  
Thyroid Autoantibodies ◽  
Thyroglobulin Antibodies ◽  
Hashimoto Encephalopathy ◽  
Generalized Seizures

The authors present a case report and review the literature on Hashimoto encephalopathy. The onset of the disease may be marked by focal and then progressively generalized seizures or other neurological symptoms, but a cognitive decline or various psychiatric symptoms may also emerge. High levels of anti-thyroid peroxidase antibodies and/or anti-thyroglobulin antibodies are present in the serum. Corticosteroid treatment usually results in an improvement of symptoms. The syndrome is frequently overlooked and, therefore, the authors strongly recommend testing serum thyroid autoantibodies in cases with encephalopathy of unknown origin independently on the presence of thyroid disease in the patient or family history. The importance of long-term immunosuppressive treatment should also be stressed. Orv. Hetil., 2013, 154, 1312–1316.

scholarly journals Emergence Delirium: Can Corticosteroids Contribute to It?

2020 ◽  
Vol 09 (04) ◽  
pp. 304-306
Author(s):  
Roger Esmel-Vilomara ◽  
Alejandro Cruz ◽  
Cristina Inoriza ◽  
Eva Andreu ◽  
Francisca Munar
Keyword(s):  
Risk Factor ◽  
Renal Biopsy ◽  
Psychiatric Symptoms ◽  
Therapeutic Option ◽  
Corticosteroid Treatment ◽  
High Dose ◽  
Emergence Delirium

AbstractWe report a case of emergence delirium after a propofol-based sedation for a renal biopsy in a teenager patient who had received high-dose and long-term corticosteroid treatment. Corticosteroid treatment is proposed as a possible risk factor for emergence delirium, although controlled studies are needed to assess this relationship. Although treatment for emergence delirium has not been well established, as described with steroid-induced psychiatric symptoms, antipsychotics could be a good therapeutic option.

Hashimoto encephalopathy in the 21st century

Neurology ◽  
2019 ◽  
Vol 94 (2) ◽  
pp. e217-e224 ◽  
Author(s):  
Simone Mattozzi ◽  
Lidia Sabater ◽  
Domingo Escudero ◽  
Helena Ariño ◽  
Thais Armangue ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Refractory Status Epilepticus ◽  
Thyroid Peroxidase ◽  
Hashimoto Encephalopathy ◽  
Euthyroid Status ◽  
Disease Specificity ◽  
Steroid Responsiveness ◽  
Mild Hypothyroidism

ObjectiveTo report the presenting syndromes and to determine whether pretreatment criteria of Hashimoto encephalopathy (HE) predict response to steroids.MethodsWe assessed symptoms and steroid responsiveness in 24 patients with pretreatment criteria of HE, including (1) subacute onset of cognitive impairment, psychiatric symptoms, or seizures; (2) euthyroid status or mild hypothyroidism; (3) serum thyroid peroxidase antibodies (TPOAb) >200 IU/mL; (4) absent neuronal antibodies in serum/CSF; and (5) no other etiologies. Additional studies included determination of TPOAb (>200 IU/mL) in 74 patients with criteria of possible autoimmune encephalitis (AE) without neuronal antibodies and 205 patients with different neuroimmunologic diseases, psychosis, or new-onset refractory status epilepticus (NORSE). Serum antibodies to the amino (ΝΗ2)-terminal of α-enolase (NH2-α-enolaseAb) were examined in the indicated 24 patients and 13 controls.ResultsThe 24 patients (14 women) with suspected HE had a median age of 48 years (range 8–79 years). Four syndromes were identified: psychiatric (7, 29%), encephalopathy (7, 29%), NORSE-like (6, 25%), and limbic encephalitis (4, 17%). Only 6 of 19 (31.6%) patients completely responded to steroids. The frequency of TPOAb in the 74 patients with possible AE (6 of 74, 8.1%) was similar to that of the 205 controls (17 of 205, 8.2%; p = 0.84). NH2-α-enolaseAb were identified in 1 of 24 suspected HE cases and 1 of 13 controls.ConclusionCurrent pretreatment criteria of HE do not predict steroid responsiveness. The detection of TPOAb across all control groups reveals their poor disease-specificity. NH2-α-enolaseAb did not help in the diagnosis of HE. These findings imply a redefinition of HE that requires a systematic exclusion of antibody-mediated encephalitis.

PD-1 blockade for disseminated Kaposi sarcoma in a patient with atopic dermatitis and chronic CD8 lymphopenia

Immunotherapy ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 451-457
Author(s):  
Thilo Gambichler ◽  
Laura Susok
Keyword(s):  
Atopic Dermatitis ◽  
Soft Tissues ◽  
Immunosuppressive Treatment ◽  
Kaposi Sarcoma ◽  
Unknown Origin ◽  
Rare Association ◽  
Mixed Response ◽  
Heavily Pretreated ◽  
History Of

We describe a 53-year-old male patient with a history of long-standing atopic dermatitis (AD) who presented with disseminated Kaposi sarcoma (KS). Although he never had received long-term immunosuppressive treatment for his AD, he had a 16-year history of CD8 lymphopenia. Because of his heavily pretreated progressive KS in lymph nodes and soft tissues, we treated the patient using pembrolizumab 2 mg/kg body weight 3-weekly. On PET-computed tomography 3-months after the initiation of pembrolizumab therapy, a solid treatment response was detected in all tumor sites – 6-months later a mixed response was observed. Pembrolizumab therapy for further 10 months resulted in stable disease. Notably, his AD also improved during the pembrolizumab treatment period. This report highlights a rare association between AD and KS that was complicated by chronic CD8 lymphopenia of unknown origin. Even though our patient was immunocompromised, he showed an overall good response to pembrolizumab treatment.

scholarly journals Euthyroid Hyperthyrotropinemia in Children Born after in Vitro Fertilization

2009 ◽  
Vol 94 (4) ◽  
pp. 1338-1341 ◽  
Author(s):  
Sophia D. Sakka ◽  
Ariadne Malamitsi-Puchner ◽  
Dimitrios Loutradis ◽  
George P. Chrousos ◽  
Christina Kanaka-Gantenbein
Keyword(s):  
In Vitro Fertilization ◽  
Assisted Reproduction ◽  
Primary Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Thyroglobulin Antibodies ◽  
Assisted Reproduction Techniques ◽  
Vitro Fertilization ◽  
Serum T3

Abstract Context: Assisted reproduction techniques are now commonly used. Although classic in vitro fertilization (IVF) started almost 30 yr ago, few long-term systematic prospective studies of children conceived with assisted reproduction have been performed. Objective: Our objective was to investigate thyroid function in children conceived after IVF vs. naturally conceived controls. Populations and Methods: A total of 106 children conceived after classic IVF and 68 naturally conceived controls, aged 4–14 yr, were studied. All children were thoroughly examined, and serum T3, T4, TSH, anti-thyroid peroxidase, and anti-thyroglobulin antibodies were measured. A second TSH determination and a thyroid ultrasound were performed for TSH higher than 5 μIU/ml, and children were considered to have persistent hyperthyrotropinemia, if the TSH elevation was confirmed. Results: Seven IVF children but none of the controls had persistent elevations of circulating TSH, suggesting euthyroid hyperthyrotropinemia or subclinical primary hypothyroidism (P = 0.044). TSH was significantly higher in the IVF group than in controls (P = 0.046), whereas no significant differences in the concentrations of T3 or T4 were observed. None of the children had detectable circulating antithyroid antibodies in either group. Conclusions: A significant elevation of serum TSH compatible with a mild TSH resistance of the thyroid were found in IVF children compared with controls. This was not due to the presence of antithyroid autoantibodies. We suggest that this might represent a slight epigenetic developmental abnormality related to the preimplantation manipulation of the embryo. Further studies are needed to confirm these findings and to better determine their etiopathogenesis and clinical significance.

scholarly journals Relationship Between Thyroid Hormonal Status in Patients with a Hypothyroid Form of Hashimoto’s Thyroiditis and Iodine Concentrations in Drinking Water

2021 ◽  
Author(s):  
Olha Kasiyan ◽  
Halyna Tkachenko ◽  
Natalia Kurhaluk ◽  
Svitlana Yurchenko ◽  
Alek Manenko
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Iodine Concentration ◽  
Iodine Intake ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Supply Network ◽  
Thyroid Status ◽  
Thyroglobulin Antibodies ◽  
Regressive Analysis

AbstractThe current study aimed to identify correlative and regressive dependencies between the water iodine concentration and the levels of TSH (thyroid-stimulating hormone), thyroglobulin antibodies (TgAbs), and thyroid peroxidase (TPOAb) in the serum of 168 in patients (34 men and 134 women) with a hypothyroid form of Hashimoto’s thyroiditis who use water from the supply network and individual wells. Based on the water iodine concentration, low and moderate degrees of iodine endemia in the location of the patients were determined. In the groups of men and women using water from different water supply sources, there were direct correlations between the water iodine concentrations and the TgAbs and TPOAb titers as well as an inverse dependence between iodine and TSH levels. Multivariate regressive analysis indicated that TgAb and TSH in the group of women using water from a supply network and TPOAb titers in the group of women using well water were independent factors associated with water iodine concentrations. Statistically significant correlations and regressive dependencies between the water iodine concentrations and the biomarkers of the thyroid status of the patients indicate the risk of Hashimoto’s thyroiditis progression, especially among women with additional iodine intake.

scholarly journals AB1045 CLINICAL, ANALYTICAL AND RADIOLOGICAL CHARACTERISTICS OF A COHORT OF PATIENTS WITH SARCOIDOSIS.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1814.2-1814
Author(s):  
I. Madroñal García ◽  
C. Aguilera Cros ◽  
L. Mendez Diaz
Keyword(s):  
Systemic Disease ◽  
Immunosuppressive Treatment ◽  
Clinical Manifestations ◽  
Corticosteroid Treatment ◽  
Pulmonary Involvement ◽  
List Type ◽  
Chi Square ◽  
Course Of Disease ◽  
Chronic Course ◽  
Radiological Stage

Background:Sarcoidosis is a systemic disease whose etiology is unknown. It is characterized by the formation of granulomas in any tissue of the organism. Ganglionic, pulmonary and cutaneus involvement is the most prevalent.Objectives:Describe clinical characteristics of a cohort of patients with sarcoidosis diagnosed.Define the association between the ACE’s number at diagnosis, radiological lung stage, treatment and course of disease.Evaluate if the extrapulmonary involvement is related to the course of the disease.Methods:Descriptive retrospective study of patients with S diagnosis treated in our Hospital in 2019. Data were obtained by reviewing medical records. Chi-square tests and parametric tests have been used to establish the differences described in the objectives.Results:102 patients diagnosed with sarcoidosis have been included, (51% females) with an average age of 56±11 years. Suspected diagnosis at the onset of disease was S in 70.6% of patients, followed by suspected lymphoma (20.6%). The average time for the definitive diagnosis of S was 9.5 months. 70.6% of the patients had elevated ACE titles at the beginning. Regarding the clinical manifestations, 18.6% of the patients presented fever at the beginning and 66.7% extrathoracic clinical manifestations. 72.5% have lymph node adenopathies, and in 91% there is thoracic involvement (the most frequent pulmonary stage is stage II). A biopsy was performed in 84.3% of the patients, the lung biopsy being the most performed (52.3%). 88.2% of patients received corticosteroid treatment at the onset of the disease (currently under treatment with corticosteroids 37.3%). 50% of patients are treated with immunosuppressants, Methotrexate was the most used. 5 patients are treated with biological therapy (AntiTNF).Regarding the course of the disease, 51% of the patients have a chronic course, 45.1% are in remission and 3.9% have suffered a relapse of the disease. In this study, no significant relationship was found between the ACE values at the onset of the disease, the pulmonary stage and the course of the disease.According to our data, patients presenting with extrathoracic clinical manifestations need more frequently corticosteroid treatment (p = 0.017) and immunosuppressive treatment (p = 0.001) with respect to patients who do not have an extrathoracic clinic. In addition, patients with an extrathoracic clinic present more frequently a chronic course of the disease than those who do not (p = 0.019).Conclusion:The results described in this study are similar to those found in the literature. The differences found can be explained because patients presenting with extrathoracic clinical manifestations have a more complicated management and need more treatment than those with only pulmonary involvement, even patients with radiological stage I do not usually need treatment, only surveillance.Disclosure of Interests:None declared

scholarly journals Affective Temperaments and Illness Severity in Patients with Bipolar Disorder

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 54
Author(s):  
Mario Luciano ◽  
Luca Steardo ◽  
Gaia Sampogna ◽  
Vito Caivano ◽  
Carmen Ciampi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bipolar Disorder ◽  
Protective Factor ◽  
Psychiatric Symptoms ◽  
Control Group ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Affective Temperaments

Background and objectives: Bipolar disorder (BD) is one of the most burdensome psychiatric illnesses, being associated with a negative long-term outcome and the highest suicide rate. Although affective temperaments can impact on BD long-term outcome, their role remains poorly investigated. The aims of the present study are to describe the clinical characteristics of patients with BD more frequently associated with the different affective temperaments and to assess the relation between affective temperaments and severity of clinical picture in a sample of patients with BD. Materials and Methods: A total of 199 patients have been recruited in the outpatients units of two university sites. Patients’ psychiatric symptoms, affective temperaments, and quality of life were investigated through validated assessment instruments. Results: Predominant cyclothymic and irritable temperaments are associated to higher number of relapses, poorer quality of life, higher rates of aggressive behaviors, and suicide attempts. Conversely, the predominant hyperthymic disposition was a protective factor for several outcome measures, including relapse rate, severity of anxiety, depressive and manic symptoms, suicidality, and earlier age at onset. One limitationo of the present study is that the recruitment took place in two university sites; therefore, our findings cannot be fully generalized to the whole community of BD patients. Other limitations are the lack of a control group and the cross-sectional design of the study. Conclusions: The early identification of affective temperaments can help clinicians to identify those BD patients who are more likely to show a poor long-term outcome. An early screening of affective temperaments can be useful to develop targeted integrated pharmacological and psychosocial interventions.

scholarly journals Obsessive–compulsive symptoms and information seeking during the Covid-19 pandemic

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alisa M. Loosen ◽  
Vasilisa Skvortsova ◽  
Tobias U. Hauser
Keyword(s):  
Mental Health ◽  
Information Seeking ◽  
Large Scale ◽  
Psychiatric Symptoms ◽  
Longitudinal Change ◽  
Depression Symptoms ◽  
Obsessive Compulsive ◽  
Related Information ◽  
Pandemic Wave

AbstractIncreased mental-health symptoms as a reaction to stressful life events, such as the Covid-19 pandemic, are common. Critically, successful adaptation helps to reduce such symptoms to baseline, preventing long-term psychiatric disorders. It is thus important to understand whether and which psychiatric symptoms show transient elevations, and which persist long-term and become chronically heightened. At particular risk for the latter trajectory are symptom dimensions directly affected by the pandemic, such as obsessive–compulsive (OC) symptoms. In this longitudinal large-scale study (N = 406), we assessed how OC, anxiety and depression symptoms changed throughout the first pandemic wave in a sample of the general UK public. We further examined how these symptoms affected pandemic-related information seeking and adherence to governmental guidelines. We show that scores in all psychiatric domains were initially elevated, but showed distinct longitudinal change patterns. Depression scores decreased, and anxiety plateaued during the first pandemic wave, while OC symptoms further increased, even after the ease of Covid-19 restrictions. These OC symptoms were directly linked to Covid-related information seeking, which gave rise to higher adherence to government guidelines. This increase of OC symptoms in this non-clinical sample shows that the domain is disproportionately affected by the pandemic. We discuss the long-term impact of the Covid-19 pandemic on public mental health, which calls for continued close observation of symptom development.

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