Lithium-induced Hashimoto's encephalopathy: a case report.
OBJECTIVE
To report on a patient with Hashimoto's encephalopathy induced by lithium. PATIENT AND INTERVENTIONS: A 61-year-old woman with a type II bipolar disorder and a history of lithium-induced thyrotoxicosis associated with silent thyroiditis was hospitalized to treat a severe major depressive episode. Given long-term treatment with levothyroxine for hypothyroidism that had resulted from silent thyroiditis, endogenous hormone in thyroid follicles was assumed to be minimized by the negative feedback, decreasing risk of recurrent thyrotoxicosis if lithium were restarted.


RESULTS
Lithium clearly relieved the patient's depressive symptoms, but after 40 days encephalopathy developed. Thyrotoxicosis was ruled out, and serum antithyroid antibody titers were elevated. In the cerebrospinal fluid, protein content was substantially elevated and antithyroid antibodies were detected. Encephalopathy resolved dramatically after course of intravenous pulse therapy with methylprednisolone.


CONCLUSIONS
We believe that autoantibodies against antigens shared by the thyroid gland and the brain were induced by exposure to lithium, causing the patient to develop Hashimoto's encephalopathy.
Nagamine
Masanori
M
Department of Psychiatry, National Defense Medical College, Tokorozawa, Saitama, Japan.
Yoshino
Aihide
A
Ishii
Motoyasu
M
Ogawa
Tetsuo
T
Kurauchi
Sachi
S
Yoshida
Takeshi
T
Shigemura
Jun
J
Kodera
Tsutomu
T
Tanaka
Yuji
Y
Nomura
Soichiro
S
D018692:Antimanic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy; D005260:Female; D050031:Hashimoto Disease / Q000139:chemically induced*; D006801:Humans; D018021:Lithium Chloride / Q000009:adverse effects*; D008875:Middle Aged
D018692:Antimanic Agents; D018021:Lithium Chloride