Download PDF
Dtsch Med Wochenschr 2002; 127(21): 1145-1150
DOI: 10.1055/s-2002-31530
Übersichten
© Georg Thieme Verlag Stuttgart · New York

Psychische Veränderungen bei Hypo- und Hyperthyreosen

Mental changes in hypo- and hyperthyroidismC. Meier, M. Christ-Crain, U. Keller, J. J. Staub
  • 1Abteilung für Endokrinologie, Diabetologie und klinische Ernährung (Leiter: Prof. Dr. med. U. Keller), Departement Innere Medizin, Universitätskliniken, Kantonsspital Basel
Further Information

Publication History

10.8.2001

26.3.2002

Publication Date:
23 May 2002 (online)

Also available at
   Permissions and Reprints
Preview

Psychiatrische Auffälligkeiten bei Patienten mit Schilddrüsenfunktionsstörungen können sehr vielgestaltig sein. So werden häufig kognitive Funktionsstörungen und depressive Zustandsbilder, seltener Angststörungen sowie psychotische Zustände mit Wahnvorstellungen und Halluzinationen beschrieben. Wie aus Fallsammlungen bekannt kann sich eine Hypo- bzw. Hyperthyreose alleine durch diese psychischen Veränderungen manifestieren, ohne dass typisch organisch geprägte Symptome bestehen müssen. Um eine zugrundeliegende Schilddrüsenerkrankung frühzeitig erkennen und gezielt behandeln zu können, ist die Kenntnis psychischer Manifestationsformen erforderlich.

Diese Übersicht soll die psychiatrischen Manifestationen bei Patienten mit Schilddrüsenfunktionsstörungen erläutern und deren diagnostische Abgrenzung zu primär psychiatrischen Erkrankungen aufzeigen.

Literatur

  • 1 Aronson R, Offman H J, Joffe R T, Naylor C D. Triiodothyronine augmentation in the treatment of refractory depression. A meta-analysis.  Arch Gen Psychiatry. 1996;  53 842-848
    Search in Google Scholar
  • 2 Attia J, Margetts P, Guyatt G. Diagnosis of thyroid disease in hospitalized patients: a systematic review.  Arch Intern Med. 1999;  159 658-665
    Search in Google Scholar
  • 3 Baldini I M, Vita A, Mauri M C. et al . Psychopathological and cognitive features in subclinical hypothyroidism.  Prog Neuropsychopharmacol Biol Psychiatry. 1997;  21 925-935
    Search in Google Scholar
  • 4 Bauer M, Hellweg R, Graf K J, Baumgartner A. Treatment of refractory depression with high-dose thyroxine.  Neuropsychopharmacology. 1998;  18 444-55
    Search in Google Scholar
  • 5 Brownlie B E, Rae A M, Walshe J W, Wells J E. Psychoses associated with thyrotoxicosis - »thyrotoxic psychosis«: A report of 18 cases, with statistical analysis of incidence.  Eur J Endocrinol. 2000;  142 4384-44
    Search in Google Scholar
  • 6 Bunevicius R, Kazanavicius G, Zalinkevicius R, Prange A J Jr. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.  N Engl J Med. 1999;  340 424-429
    Search in Google Scholar
  • 7 Calabrese J R, Gulledge A D, Hahn K. et al . Autoimmune thyroiditis in manic-depressive patients treated with lithium.  Am J Psychiatry. 1985;  142 1318-1321
    Search in Google Scholar
  • 8 Caudill T G, Lardinois C K. Severe thyrotoxicosis presenting as acute psychosis.  West J Med. 1991;  155 292-293
    Search in Google Scholar
  • 9 Cho J T, Bone S, Dunner D L, Colt E, Fieve R R. The effect of lithium treatment on thyroid function in patients with primary affective disorder.  Am J Psychiatry. 1979;  136 115-116
    Search in Google Scholar
  • 10 Chopra I J, Solomon D H, Huang T S. Serum thyrotropin in hospitalized psychiatric patients: evidence for hyperthyrotropinemia as measured by an ultrasensitive thyrotropin assay.  Metabolism. 1990;  39 538-543
    Search in Google Scholar
  • 11 Cooper D S, Halpern R, Wood L C, Levin A A, Ridgway E C. L-Thyroxine therapy in subclinical hypothyroidism. A double-blind, placebo-controlled trial.  Ann Intern Med. 1984;  101 18-24
    Search in Google Scholar
  • 12 Cowdry R W, Wehr T A, Zis A P, Goodwin F K. Thyroid abnormalities associated with rapid-cycling bipolar illness.  Arch Gen Psychiatry. 1983;  40 414-420
    Search in Google Scholar
  • 13 De Groot L J. Dangerous Dogmas in Medicine: The Nonthyroidal Illness Syndrome.  J Clin Endocrinol Metab. 1999;  84 151-64
    Search in Google Scholar
  • 14 Eagles J M, McCann I, MacLeod T N, Paterson N. Lithium monitoring before and after the distribution of clinical practice guidelines.  Acta Psychiatr Scand. 2000;  101 349-353
    Search in Google Scholar
  • 15 Enns M, Ross C, Clark P. Thyroid screening tests in psychiatric inpatients.  Gen Hosp Psychiatry. 1992;  14 334-339
    Search in Google Scholar
  • 16 Escobar-Morreale H F, del Rey F E, Obregon M J, de Escobar G M. Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues of the thyroidectomized rat.  Endocrinology. 1996;  137 2490-2502
    Search in Google Scholar
  • 17 Geffken G R, Ward H E, Staab J P, Carmichael S L, Evans D L. Psychiatric morbidity in endocrine disorders.  Psychiatr Clin North Am. 1998;  21 473-489
    Search in Google Scholar
  • 18 Granet R B, Kalman T P. Hypothyroidism and psychosis: a case illustration of the diagnostic dilemma in psychiatry.  J Clin Psychiatry. 1978;  39 260-263
    Search in Google Scholar
  • 19 Gunnarsson T, Sjoberg S, Eriksson M, Nordin C. Depressive symptoms in hypothyroid disorder with some observations on biochemical correlates.  Neuropsychobiology. 2001;  43 70-74
    Search in Google Scholar
  • 20 Haggerty J J, Stern R A, Mason G A, Beckwith J, Morey C E, Prange A J. Subclinical hypothyroidism: a modifiable risk factor for depression?.  American Journal of Psychiatry. 1993;  150 508-510
    Search in Google Scholar
  • 21 Hall R C. Psychiatric effects of thyroid hormone disturbance.  Psychosomatics. 1983;  24 7-11, 15 - 18
    Search in Google Scholar
  • 22 Howland R H. Thyroid dysfunction in refractory depression: implications for pathophysiology and treatment.  J Clin Psychiatry. 1993;  54 47-54
    Search in Google Scholar
  • 23 Hutto B. Subtle psychiatric presentations of endocrine diseases.  Psychiatr Clin North Am. 1998;  21 905-916, viii
    Search in Google Scholar
  • 24 Jaeschke R, Guyatt G, Gerstein H. et al . Does treatment with L-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism?.  J Gen Intern Med. 1996;  11 744-749
    Search in Google Scholar
  • 25 Jefferson J W. Lithium: the present and the future.  J Clin Psychiatry. 1990;  51 (Suppl) 4-8; discussion 17 - 9
    Search in Google Scholar
  • 26 Johnston A M, Eagles J M. Lithium-associated clinical hypothyroidism. Prevalence and risk factors.  Br J Psychiatry. 1999;  175 336-339
    Search in Google Scholar
  • 27 Kirov G. Thyroid disorders in lithium-treated patients.  J Affect Disord. 1998;  50 33-40
    Search in Google Scholar
  • 28 Lederbogen F, Hermann D, Hewer W, Henn F A. Thyroid function test abnormalities in newly admitted psychiatric patients residing in an iodine-deficient area: patterns and clinical significance.  Acta Psychiatr Scand. 2001;  104 305-310
    Search in Google Scholar
  • 29 Leigh H, Kramer S I. The psychiatric manifestations of endocrine disease.  Adv Intern Med. 1984;  29 413-45
    Search in Google Scholar
  • 30 Lerch M, Meier C, Staub J J. Is there a need for treatment in subclinical hypo- and hyperthyroidism?.  Ther Umsch. 1999;  56 369-373
    Search in Google Scholar
  • 31 Leutgeb U. Ambient iodine and lithium-associated with clinical hypothyroidism.  Br J Psychiatry. 2000;  176 495-496
    Search in Google Scholar
  • 32 Logotheis J. Psychotic behavior as the initial indicator of adult myxedema.  J Nerv Ment Dis. 1963;  136 561-568
    Search in Google Scholar
  • 33 Loosen P T, Prange A J. Serum thyrotropin response to thyrotropin-releasing hormone in psychiatric patients: a review.  Am J Psychiatry. 1982;  139 405-416
    Search in Google Scholar
  • 34 Magliozzi J R, Maddock R J, Gold A S, Gietzen D W. Relationships between thyroid indices and symptoms of anxiety in depressed outpatients.  Ann Clin Psychiatry. 1993;  5 111-116
    Search in Google Scholar
  • 35 Meier C, Staub J J, Roth C B. et al . Tsh-controlled l-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double blind, placebo-controlled trial (Basel Thyroid Study).  J Clin Endocrinol Metab. 2001;  86 4860-4866
    Search in Google Scholar
  • 36 Monzani F, Del Guerra P, Caraccio N. et al . Subclinical hypothyroidism: neurobehavioral features and beneficial effect of L-thyroxine treatment.  Clinical Investigator. 1993;  71 367-371
    Search in Google Scholar
  • 37 Nystrom E, Caidahl K, Fager G, Wikkelso C, Lundberg P A, Lindstedt G. A double-blind cross-over 12-month study of L-thyroxine treatment of women with »subclinical« hypothyroidism.  Clin Endocrinol (Oxf). 1988;  29 63-75
    Search in Google Scholar
  • 38 Placidi G P, Boldrini M, Patronelli A. et al . Prevalence of psychiatric disorders in thyroid diseased patients.  Neuropsychobiology. 1998;  38 222-225
    Search in Google Scholar
  • 39 Smith C K, Barish J, Correa J, Williams R H. Psychiatric disturbance in endocrinologic disease.  Psychosom Med. 1972;  34 69-86
    Search in Google Scholar
  • 40 Taylor J W. Depression in thyrotoxicosis.  Am J Psychiatry. 1975;  132 552-553
    Search in Google Scholar
  • 41 Whybrow P C, Bauer M. Behavioral and psychiatric aspects of hypothyroidism. 8 ed. New York: Lippincott Williams and Wilkins In: Braverman LE, Utiger RU, eds. Werner and Ingbar’s The Thyroid 2000: 837
    Search in Google Scholar
  • 42 Whybrow P C, Bauer M. Behavioral aspects of thyrotoxicosis. 8 ed. New York: Lippincott Williams and Wilkins In: Braverman LE, Utiger RU, eds. Werner and Ingbar’s The Thyroid 2000: 673
    Search in Google Scholar
  • 43 Woolf P D, Nichols D, Porsteinsson A, Boulay R. Thyroid evaluation of hospitalized psychiatric patients: the role of TSH screening for thyroid dysfunction.  Thyroid. 1996;  6 451-456
    Search in Google Scholar

Dr. Christian Meier

Abteilung für Endokrinologie, Diabetologie und klinische Ernährung, Universitätskliniken, Kantonsspital Basel

Petersgraben 4

4031 Basel, Schweiz

Phone: ++41/61/2655323

Fax: ++41/61/2655100

Email: cmeier@uhbs.ch