Acute psychosis in a pregnant patient with Graves’ hyperthyroidism and anti-NMDA receptor encephalitis

BMJ Case Reports - Trang bcr2014208052
Jinhong Lu1, Susan L. Samson1, Joseph S. Kass2, Nalini Ram1
1Department of Medicine Endocrinology, Baylor College of Medicine, Houston, Texas, USA.
2Department of Neurology, Baylor College of Medicine, Houston, Texas USA

Tóm tắt

A previously healthy 36-year-old woman presented with visual hallucinations and acute psychosis manifested predominantly as hypersexuality. Laboratory testing demonstrated elevated free thyroxine levels, suppressed thyroid-stimulating hormone levels and presence of thyroid-stimulating immunoglobulin andthyroid peroxidase (TPO) antibodiesconsistent with Graves’ disease. Despite achieving biochemical euthyroidism, she remained profoundly hypersexual. She did not respond to additional treatment with antipsychotics and corticosteroids, prompting further evaluation. Cerebrospinal fluid analysis detected pleocytosis, elevated IgG, and presence of antibodies against anti-N-methyl-D-aspartate receptor (NMDAR), glutamic acid decarboxylase 65 and TPO. These results suggested a diagnosis of anti-NMDAR encephalitis. Prior to initiation of immunomodulator therapy, she was discovered to be pregnant with date of conception around the time of her original presentation. She received plasmapheresis with resolution of psychosis and decrease in free thyroxine levels. Graves’ disease remitted during the remainder of the pregnancy but relapsed 5 months post partum. She has not had further neuropsychiatric symptoms.

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Tài liệu tham khảo

10.2165/00023210-200620110-00003

10.1176/jnp.8.2.181

Whybrow PC , Bauer M . Behavioral and psychiatric aspects of thyrotoxicosis. In: Braverman LE , Utiger RD . eds. Werner & Ingbar's the thyroid: a fundamental and clinical text. 9th edn. Philadelphia, PA: Lippincott Williams and Wilkins, 2005:644–50.

10.1001/jamaneurol.2013.3216

10.1016/S1474-4422(08)70225-4

10.1016/S1474-4422(08)70224-2

10.1016/S1474-4422(12)70310-1

10.1016/j.amjmed.2009.06.030

De Leu, 2012, Seizures and postictal stupor in a patient with uncontrolled Graves’ hyperthyroidism, BMJ Case Rep, 2012, pii: bcr0220125929, 10.1136/bcr.02.2012.5929

10.1097/AOG.0b013e31825935d4

10.1212/WNL.57.5.780

10.1093/brain/awn183

10.1089/thy.2010.0159

10.1002/jca.20200

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