Table 4 Case series
From: Bipolar disorder and antithyroid antibodies: review and case series
# | Psychiatric diagnosis, (age at onset) | Sex (current age) | Age at first measurement of circulating antibodies | Antibody titer when first detected (normal range) | Thyroid diagnostic and therapeutic procedures | Treatment | Notes |
|---|---|---|---|---|---|---|---|
1 | Bipolar I (41) | F (70) | 50 | AbM 1:1600 AbTPO 397 (0–100) | Thyroidectomy at age 63 (histology: multinodular goiter plus chronic lymphocytic thyroiditis) Levothyroxine replacement since thyroidectomy | Poor response to 1 year of lithium. Partial response to valproate (age 52–70) | Cognitive impairment, limb and head tremor, MRI abnormalities Excision of nodule at age 20 (no histology available) |
2 | Bipolar II (23) | F (76) | 54 | AbTPO 1661 (0–20) AbM 1:102,400 AbTG 1:100 | Non-homogeneous echopattern. Levothyroxine for hypothyroidism since age 54 | Lithium response for 21 years (age 42–63), then poor response | Hand and leg tremor, cognitive decline to dementia, MRI and SPECT abnormalities |
3 | Schizoaffective (23) | F (41) | 25 | AbTPO 1567 (0–20) | Non-homogeneous hypoechoic echopattern Levothyroxine for hypothyroidism since age 25 | Poor response to 1 year of lithium. Partial response to clozapine (age 25–41) | Recurrent auditory hallucinations, SPECT abnormalities |
4 | Bipolar II (45) | F (74) | 51 | AbM 1188 (0–50) AbTG 829 (0–50) | Echopattern of thyroiditis plus nodules at age 51 TSH-suppressive levothyroxine for goiter since age 51 | Excellent response to lithium (age 46–74) | Head tremor Suspected thyroid dysfunction during adolescence |
5 | Recurrent major depression (38) | F (87) | 61 | AbM 1:65,536 AbTPO 6393 (0–200)00 | Diffuse non-homogeneous echopattern plus multiple nodules No thyroid treatment | Excellent response to lithium (age 57–87) | Head tremor. |
6 | Bipolar I (39) | F (64) | 61 | AbTPO 255 (0–35) | Hyperthyroidism after lithium withdrawal, treated with methimazole Diffuse non-homogeneous echopattern plus multiple nodules | Good lithium response (age 49–59). Lithium + haloperidol between age 61 and 64 | AbTPO >2000 (0–35) at age 62, 1 year after new lithium prescription |
7 | Chronic depressive schizoaffective disorder (17) | F (46) | 30 | AbTPO positive (titer not available) | Echopattern of thyroiditis (not otherwise specified) Levothyroxine for hypothyroidism since age 35 | Poor response to first-generation antipsychotics and carbamazepine. Partial response to clozapine (age 30–40). Partial response to clozapine + lithium (age 40–46) | AbTPO 3150 (0–35) at age 40 SPECT abnormalities |
8 | Depressive schizoaffective disorder (26) | F (48) | 40 | AbM 1:25,600 | Non-homogeneous echopattern plus multiple nodules. Fine needle aspiration consistent with Hashimoto’s thyroiditis Levothyroxine for hypothyroidism since age 42 | Partial response to lithium (age 32–48) | AbTPO 7757 (0–200) at age 42 and 655 (0–20) at age 45 Tremors of hands, legs, mouth and tongue |
9 | Psychotic bipolar I (23) | F (54) | 37 | AbM 1:1600 AbTG negative | Echopattern consistent with thyroiditis (not otherwise specified) Levothyroxine for hypothyroidism since age 39 | Good response to lithium (age 37–54) | Highest AbTPO titer 862 (0–20) Autoimmune polyendocrine syndrome first diagnosed at age 50 |
10 | Psychotic bipolar I (24) | M (72) | 48 | AbTPO 578 (0–200) AbM 1:6400 AbTG 1:400 | Subclinical hypothyroidism and hyperthyroidism between age 43 and 48. Diffuse non-homogeneous echopattern | Excellent response to lithium (age 35–53) and subsequently to carbamazepine (age 53–72) after diagnosis of renal failure | Highest AbTPO titer 315 (0–20) EEG abnormalities at age 43 |
11 | Schizoaffective disorder (24) | F (43) | 31 | AbTPO 172 (0–10) AbM 1:6400 AbTG negative | Echopattern consistent with thyroiditis (not otherwise specified) Levothyroxine for hypothyroidism since age 33 | Poor response to lithium + carbamazepine (poor adherence to treatment) | Normal antibodies at age 28 Highest AbTPO titer 3063 (0–120) |
12 | Bipolar schizoaffective disorder (33) | F (57) | 49 | AbTPO 4260 (0–100) AbTG 100 IU/ml (0–100) | Echopattern consistent with thyroiditis (not otherwise specified) Levothyroxine for hypothyroidism since age 49 | Partial response to lithium + haloperidol (age 38–57) | AbTPO titer 241 (0–10) with AbM 1:25,600 at age 53 Suspected Sjögren syndrome at age 56 |
13 | Bipolar I (38) | F (49) | 46 | AbTPO 1072 (0–9) AbTG 65 (0–4) | Echopattern consistent with thyroiditis (not otherwise specified) Levothyroxine for hypothyroidism since age 46 | Partial response to lithium + quetiapine (age 46–49) | Multiple sclerosis first diagnosed at age 20. |
14 | Psychotic bipolar I (23) | F (60) | 44 | AbTPO 514 (0–35) | Non-homogeneous echopattern plus multiple nodules Levothyroxine for hypothyroidism since age 44 | Partial response to valproate (age 51–58). Good response to valproate + lithium (age 58–60) | Celiac disease first diagnosed at age 44 |