Introduction: Thyroid states can be associated with psychiatric manifestations, be it hypothyroid, hyperthyroid or even euthyroid. The effect of depression is significant in subclinical hypothyroidism. Sometimes, its signs and symptoms are indistinguishable from Major Depressive Disorder. Our immunological system and early embryologic origins also play a role in the coexistence of other comorbidities like Pernicious Anemia. Case: A 35-year-old Hispanic female presented with significant low mood, somnolence, weight gain, increased hunger, cold intolerance and epigastric pain. It is important to note the variety of clinical manifestations of our hypothyroidism patient to understand its associations and help us with a better approach to treatment. Discussion: Standard approaches to treatment of Subclinical Hypothyroidism will depend mostly on laboratory findings such as TSH levels and free T4. Individualized therapy chosen for our patient was based on his mood symptoms, laboratory findings and coexistence of Pernicious Anemia. The use of daily 0.025 mg of levothyroxine, 10 mg of escitalopram oxalate and weekly injections of cyanocobalamin were treatments of choice. Conclusion: During follow up of our patient, we can conclude that Levothyroxine and Escitalopram Oxalate were able to improve hypothyroidism symptoms, reduce thyroglobulin and peroxidase antibodies and improve mood symptoms including cognitive functions. In addition to this, weekly cyanocobalamin injections were integrated into the management. As parietal cell antibodies decreased, gastrointestinal symptoms also disappeared. By addressing the concerns of our patient, we improved quality of care, and this is reflected in the patient’s wellbeing in physical and psychological.
References
[1]
Fatourechi, V. (2009) Subclinical Hypothyroidism: An Update for Primary Care Physicians. Mayo Clinic Proceedings, 84, 65-71. https://doi.org/10.4065/84.1.65
[2]
Adlin, V. (1998) Subclinical Hypothyroidism: Deciding When to Treat. American Family Physician, 57, 776-780.
[3]
Kroenke, K. and Spitzer, R.L. (2002) The PHQ-9: A New Depression Diagnostic and Severity Measure. Psychiatric Annals, 32, 509-521. https://doi.org/10.3928/0048-5713-20020901-06
[4]
Cellini, M., Santaguida, M.G., Virili, C., Capriello, S., Brusca, N., Gargano, L. and Centanni, M. (2017) Hashimoto’s Thyroiditis and Autoimmune Gastritis. Frontiers in Endocrinology, 8, Article No. 92. https://doi.org/10.3389/fendo.2017.00092
[5]
Vanderpump, M.P., Tunbridge, W.M., French, J.M., Appleton, D., Bates, D., Clark, F., Grimley Evans, J., Rodgers, H., Tunbridge, F. and Young, E.T. (1996) The Development of Ischemic Heart Disease in Relation to Autoimmune Thyroid Disease in a 20-Year Follow-Up Study of an English Community. Thyroid, 6, 155-160.
[6]
Dayan, C.M. and Daniels, G.H. (1996) Chronic Autoimmune Thyroiditis. The New England Journal of Medicine, 335, 99-107. https://doi.org/10.1056/NEJM199607113350206
[7]
Khan, M.A., Ahsan, T., Rehman, U.L., Jabeen, R. and Farouq, S. (2017) Subclinical Hypothyroidism: Frequency, Clinical Presentations and Treatment Indications. Pakistan Journal of Medical Sciences, 33, 818-822. https://doi.org/10.12669/pjms.334.12921
[8]
Nicoletti, A., Bal, M., De Marco, G., Baldazzi, L., Agretti, P., Menabò, S., Ballarini, E., Cicognani, A., Tonacchera, M. and Cassio, A. (2009) Thyrotropin-Stimulating Hormone Receptor Gene Analysis in Pediatric Patients with Non-Autoimmune Subclinical Hypothyroidism. The Journal of Clinical Endocrinology and Metabolism, 94, 4187-4194. https://doi.org/10.1210/jc.2009-0618
[9]
Cerbone, M., Agretti, P., De Marco, G., et al. (2013) Non-Autoimmune Subclinical Hypothyroidism Due to a Mutation in TSH Receptor: Report on Two Brothers. Italian Journal of Pediatrics, 39, Article No. 5. https://doi.org/10.1186/1824-7288-39-5
[10]
Jain, D., Aggarwal, H.K. and Dahiya, S. (2016) A Case Report on Severe Hypothyroidism Associated with Complete Bilateral Ptosis: A Rare Presentation. Journal of the ASEAN Federation of Endocrine Societies, 31, 65-67. https://doi.org/10.15605/jafes.031.01.12
[11]
Haggerty Jr., J.J., Stern, R.A., Mason, G.A., Beckwith, J., Morey, C.E. and Prange Jr., A.J. (1993) Sub-Clinical Hypothyroidism: A Modifiable Risk Factor for Depression? The American Journal of Psychiatry, 150, 508-510. https://doi.org/10.1176/ajp.150.3.508
[12]
Kahaly, G. (2009) Polyglandular Autoimmune Syndromes. Polyglandular Autoimmune Syndromes. European Journal of Endocrinology, 161, 11-20. https://doi.org/10.1530/EJE-09-0044
[13]
Tudhope, G.R. and Wilson, G.M. (1960) Anaemia in Hypothyroidism. Incidence, Pathogenesis, and Response to Treatment. The Quarterly journal of medicine, 29, 513-537.
[14]
Lu, J.-Y. and Huang, T.-S. (2000) Pernicious Anemia in Two Cases of Subclinical Hypothyroidism. Journal of Internal Medicine, 11, 126-131.