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Introduction Psychiatric manifestations are exceptional during hypothyroidism and are not always easy to diagnose, especially since the clinical signs of hypothyroidism can be confused with those of the depressive syndrome. We report an original observation of depression of the elderly revealing an isolated primary hypothyroidism.
Observation A 78-year-old patient, followed for essential hypertension, well-balanced under monotherapy with calcium channel blockers, and without degenerative complications, was referred by her family doctor for depressive syndrome not improved by the specific treatment prescribed and correctly taken for six months. The clinical examination noted in particular macroglossia with dental impressions and dry and cracked skin. The biological assessment showed hypothyroidism with TSH at 28 μmol/l. Thyroid ultrasound showed atrophy of the thyroid gland. The thyroid autoimmunity (anti-thyroglobulin and anti-thyroperoxidase antibodies) was negative. The rest of the biological tests were in the normal range. The diagnosis of Riedel’s thyroiditis was retained and the patient was treated with levothyroxine in progressive doses until TSH normalization was achieved. The evolution on the psychiatric level was also favorable with disappearance of the signs of the depression and the anti-depressive treatment was discontinued.
Conclusion Depression is rare, complicating only 4% of overt hypothyroidism and its diagnosis is not always easy, especially in the elderly. Hormone replacement therapy significantly improves the depressive syndrome and protects against cognitive decline. Thus, hypothyroidism screening seems appropriate for any depressive syndrome in the elderly.
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- Chaker L, Bianco AC, Jonklaas J, et al. Hypothyroidism. Lancet, 2017, 390(10101): 1550-1562. https://doi.org/10.1016/S0140-6736(17)30703-1
- Udovcic M, Pena RH, Patham B, et al. Hypothyroidism and the Heart. Methodist Debakey Cardiovasc J, 2017, 13(2): 55-59. https://doi.org/10.14797/mdcj-13-2-55
- Baumgartner C, Blum MR, Rodondi N. Subclinical hypothyroidism: summary of evidence in 2014. Swiss Med Wkly, 2014, 144: w14058. https://doi.org/10.4414/smw.2014.14058
- Decandia F. Risk factors for cardiovascular disease in subclinical hypothyroidism. Ir J Med Sci, 2017, May 10. doi: 10.1007/s11845-017-1617-9. [Epub ahead of print] https://doi.org/10.1007/s11845-017-1617-9
- Redford C, Vaidya B. Subclinical hypothyroidism: Should we treat? Post Reprod Health, 2017, 23(2): 55-62. https://doi.org/10.1177/2053369117705058
- Garmendia Madariaga A, Santos Palacios S, Guilln-Grima F, et al. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab, 2014, 99(3): 923-31. https://doi.org/10.1210/jc.2013-2409
- Bouomrani S, Regaeg N, Ben Hamad M, et al. An Unexpected Etiology of Rhizomelic Pseudo-Polyarthritis (Polymyalgia Rheumatica) in the Elderly. Archives of Orthopedics and Rheumatology, 2018, 1(1): 12-16.
- Bouomrani S, Lassoued N, Ben Hamad M, et al. Recurrent Intestinal Obstruction Revealing Hypothyroidism. Archives of Gastroenterology and Hepatology, 2018, 1(1): 22-25.
- Bouomrani S, Regaieg N, Belgacem N, et al. Myositis-Like Syndrome Revealing Hypothyroidism. Archives of Diabetes and Endocrine System, 2018, 1(2): 1-3.
- Kate S, Dhanwal DK, Kumar S, et al. Acute psychosis as a presentation of hypopituitarism. BMJ Case Rep, 2013. pii: bcr2012008516.
- Hernndez-Ramrez DA, Castellanos-Jurez JC, Romero T, et al. Mixedematous ileus; acute abdomen exacerbate. Rev Gastroenterol Mex, 2008, 73(4): 231-234.
- Lmanov Z. Thyroid disease in the elderly. Vnitr Lek, 2018, 64(11): 993-1002.
- Talaei A, Rafee N, Rafei F, et al. TSH cut off point based on depression in hypothyroid patients. BMC Psychiatry, 2017, 17(1): 327. https://doi.org/10.1186/s12888-017-1478-9
- Bathla M, Singh M, Relan P. Prevalence of anxiety and depressive symptoms among patients with hypothyroidism. Indian J Endocrinol Metab, 2016, 20(4): 468-474. https://doi.org/10.4103/2230-8210.183476
- Samuels MH. Psychiatric and cognitive manifestations of hypothyroidism. Curr Opin Endocrinol Diabetes Obes, 2014, 21(5): 377-383. https://doi.org/10.1097/MED.0000000000000089
- Feldman AZ, Shrestha RT, Hennessey JV. Neuropsychiatric manifestations of thyroid disease. Endocrinol Metab Clin North Am, 2013, 42(3): 453-476. https://doi.org/10.1016/j.ecl.2013.05.005
- Davis JD, Tremont G. Neuropsychiatric aspects of hypothyroidism and treatment reversibility. Minerva Endocrinol, 2007, 32(1): 49-65.
- Sathya A, Radhika R, Mahadevan S, et al. Mania as a presentation of primary hypothyroidism. Singapore Med J, 2009, 50(2): e65-67.
- Trachtenberg E, Passos IC, Kleina WW, et al. Hypothyroidism and severe neuropsychiatric symptoms: a rapid response to levothyroxine. Braz J Psychiatry, 2012, 34(4): 501-504. https://doi.org/10.1016/j.rbp.2012.04.003
- Zavareh AT, Jomhouri R, Bejestani HS, et al. Depression and Hypothyroidism in a Population-Based Study of Iranian Women. Rom J Intern Med, 2016, 54(4): 217-221. https://doi.org/10.1515/rjim-2016-0033
- Fugger G, Dold M, Bartova L, et al. Comorbid thyroid disease in patients with major depressive disorder - results from the European Group for the Study of Resistant Depression (GSRD). Eur Neuropsychopharmacol, 2018, 28(6): 752- 760 https://doi.org/10.1016/j.euroneuro.2018.03.011
- Siegmann EM, Mller HHO, Luecke C, et al. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis. JAMA Psychiatry, 2018, 75(6): 577-584. https://doi.org/10.1001/jamapsychiatry.2018.0190
- Tayde PS, Bhagwat NM, Sharma P, et al. Hypothyroidism and Depression: Are Cytokines the Link? Indian J Endocrinol Metab, 2017, 21(6): 886-892. https://doi.org/10.4103/ijem.IJEM 265 17
- Ayala AR, Danese MD, Ladenson PW. When to treat mild hypothyroidism. Endocrinol Metab Clin North Am, 2000, 29(2): 399-415. https://doi.org/10.1016/S0889-8529(05)70139-0