자가 면역성 갑상선 질환이 수반된 단기 순환형 정서장애

A Case of Rapid Cycling Affective Disorder with Autoimmune Thyroiditis

The authors experienced one case of rapid cycling affective disorder with autoimmune thyroiditis. The case was a 28-year-old female patient who showed rapid cycling with only recurrent manic attacks and poor response to conventional treatment of bipolar disorder. We observed that overt clinical hypothyrodism with high titer of thyroid autoantibodies (antimicrosomal and antithyroglobulin) occured during treatment with lithium, chlorpromazine and carbamazepine. Although hypothyroidism returned to euthyroid state with the use of replacement L-thyroxine, manic attack recurred, so we suggested that the course of rapid cycling has no relation with thyroid dysfunction. However, further evaluation of the relationship between rapid cycling affective disorder and thyroid dysfunction will be required. Recent studies have suggested that rapid cycler have higher prevalence of both clinical hypothyroidism and abnormal thyroid function test than non-rapid cycler, and especially in presence of latent autoimmune thyroiditis, lithium likely to cause clinical hypothyroidism. Therefore we considered that both baseline and periodic asessment of thyroid function and monitoring antithyroid antibodies during lithium treatment should be required.