Delirious Mania Associated with Autoimmune Gastrothyroidal Syndrome of a Mid-Life Female: The Role of Hashimoto Encephalopathy and a 3-Year Follow-Up including Serum Autoantibody Levels
Table 1
Course of treatment and laboratory results.
(a)
Treatment day
Clinical features
ICDSC-points
YMRS-points
EEG-rhythm
TSH (0,4–4,0 U/mL)
fT3 (3,5–6.5 pmol/L)
fT4 (11,5–22,7 pmol/L)
TPO-Abs (<34 IU/L)
TR-Abs (<1,75 IE/L)
PC-Abs (<1/10 titers)
1
Hypoactive delirium
7
n/a
7.5/s
91.44
<0,3
2.40
n/a
n/a
n/a
3
Mixed delirium
7
n/a
n/a
66.61
1.30
7.23
334.00
24.00
n/a
5
Mixed delirium
5
n/a
11/s
50.25
1.60
9.00
n/a
n/a
n/a
9
Mixed delirium
4
n/a
10/s
43.50
2.60
13.96
n/a
n/a
n/a
15
Hyperactive delirium, euphoric mania
4
39
n/a
38.80
3.60
19.90
n/a
n/a
n/a
22
Euphoric mania
3
24
8/s
20.57
3.60
20.26
323.00
26.96
n/a
26
Hyperactive delirium, euphoric mania
6
47
8/s
17.27
n/a
n/a
274.00
24.73
n/a
29
Euphoric mania
3
39
7,5/s
2.52
4.10
24.45
n/a
n/a
n/a
36
Euphoric mania
3
33
8/s
4.18
4.30
23.96
249.00
21.14
n/a
43
Hypomania
0
12
10,5/s
2.30
3.70
19.99
212.00
n/a
n/a
50
Hypomania
0
8
9,5/s
1.03
n/a
n/a
208.00
n/a
n/a
57
Normal
0
2
n/a
9.90
n/a
n/a
188.00
55.10
n/a
64
Normal
0
1
n/a
11.69
4.10
19.46
n/a
n/a
1/80
71
Normal
0
1
n/a
15.15
4.40
19.92
n/a
n/a
n/a
78
Normal
0
0
9/s
4.72
4.60
22.66
159.00
8.71
1/80
83
Normal
0
0
n/a
3.24
4.70
23.72
165.00
8.40
n/a
90
Normal
0
0
9,5/s
5.08
n/a
n/a
139.00
n/a
n/a
119
Normal
0
0
10/s
0.11
n/a
n/a
135.00
4.69
n/a
140
Normal
0
0
10/s
0.03
6.90
30.16
152.00
5.00
1/320
176
Normal
0
0
9/s
n/a
n/a
n/a
172.00
5.65
n/a
261
Normal
0
0
11/s
0.01
6.40
32.55
229.00
6.16
>1/1280
323
Normal
0
0
9,5/s
0.10
22.60
4.70
226.00
4.52
>1/1280
367
Normal
0
0
9,5/s
0.51
4.50
23.22
246.00
2.69
>1/1280
437
Normal
0
0
9,5/s
0.05
6.3
24.68
261.00
n/a
>1/1280
595
Normal
0
0
n/a
0.39
4.5
22.99
337.00
0.37
>1/1280
842
Normal
0
0
9,5/s
0.98
n/a
n/a
291.00
<03
>1/1280
1104
Normal
0
0
10/s
1.83
4.10
16.35
348.00
0.47
>1/1280
1264
Normal
0
0
10/s
2.96
4.00
16.12
345.00
0.39
>1/1280
(b)
Treatment day
Clinical features
Prednisolone (mg/day)
L-Thyroxine (μg/day)
RBC (4.1–5.1 million cells/mcL)
Hemoglobin (12–18 g/dL)
MCV (77–91 fL)
Lipase (73–393 U/L)
AST (0–35 U/L)
LDH (0–249 U/L)
CK (0–190 U/L)
Cholesterol (0–260 mg/dL)
1
Hypoactive delirium
125 IV
250 IV
3.27
10.50
95.10
230.00
89.00
898.00
3358.00
766.00
3
Mixed delirium
250 IV
150
2.85
8.90
96.00
218.00
47.00
597.00
1899.00
n/a
5
Mixed delirium
100
150
2.79
8.80
95.80
499.00
46.00
591.00
n/a
n/a
9
Mixed delirium
50
150
2.96
8.80
97.20
582.00
28.00
589.00
200.00
n/a
15
Hyperactive delirium, euphoric mania
50
150
3.11
9.80
98.80
836.00
16.00
497.00
92.00
n/a
22
Euphoric mania
25
150
3.13
9.90
98.10
189.00
7.00
292.00
31.00
512.00
26
Hyperactive delirium, euphoric mania
1000 IV
150
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
29
Euphoric mania
100
150
3.28
10.20
96.00
345.00
6.00
n/a
24.00
530.00
36
Euphoric mania
60
150
3.32
10.40
95.90
283.00
8.00
227.00
24.00
383.00
43
Hypomania
50
150
3.50
10.50
95.20
183.00
7.00
218.00
18.00
294.00
50
Hypomania
30
150
3.16
9.50
93.50
217.00
10.00
202.00
20.00
251.00
57
Normal
25
150
3.58
10.70
95.30
204.00
11.00
236.00
21.00
268.00
64
Normal
15
150
3.76
11.00
94.60
n/a
n/a
n/a
n/a
n/a
71
Normal
10
175
3.66
10.90
93.90
183.00
13.00
210.00
28.00
n/a
78
Normal
8
175
3.55
10.40
92.10
n/a
n/a
213.00
n/a
n/a
83
Normal
8
175
4.09
12.00
90.30
212.00
11.00
203.00
34.00
n/a
90
Normal
5
175
4.03
11.90
89.00
n/a
n/a
n/a
n/a
243.00
119
Normal
5
175
4.12
11.50
89.30
n/a
n/a
n/a
52.00
n/a
140
Normal
5
175
4.26
11.90
87.40
n/a
14.00
n/a
60.00
n/a
176
Normal
3
150
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
261
Normal
1
100
4.40
12.60
87.30
n/a
21.00
n/a
86.00
317.00
323
Normal
0
87.50
4.13
11.80
88.10
129.00
16.00
n/a
106.00
265.00
367
Normal
0
87.50
4.45
13.00
92.40
n/a
14.00
n/a
n/a
n/a
437
Normal
0
87.50
4.31
12.8
91.6
n/a
17
n/a
n/a
n/a
595
Normal
0
87.50
4.24
13
91.5
144
20
n/a
100
295
842
Normal
0
75
4.21
12.4
89.7
n/a
16
n/a
87
290
1104
Normal
0
75
4.29
12.8
90.1
159
11
208
68
296
1264
Normal
0
75
4.33
12.8
90.8
140
9
205
108
301
YMRS (normal ≤ 5, mildly manic 5–19, moderately manic 20–29 points, severely manic ≥ 30 points) [6]. ICDSC: ≥4 points = delirium, 1–3 points = suspicion of subsyndromal delirium, 0 points = no delirium [7]. Methylprednisolone. Italic numbers indicate inpatient treatment days. Days 1–14: intensive care unit, days 15–28 and days 29–64 closed and open psychiatric ward, respectively. Afterwards, outpatient treatment. TSH (thyroid-stimulating hormone), free thyroxine (fT4), free triiodothyronine (fT3), TPO-Abs (thyroid-peroxidase autoantibodies), TR-Abs (TSH-receptor autoantibodies), PC-Abs (autoantibodies against parietal cells). Normal ranges of serum lab results in brackets. Pathological results in bold letters/numbers.
