Der Nuklearmediziner 2013; 36(04): 250-255
DOI: 10.1055/s-0033-1355409
Schilddrüsenerkrankungen und Stoffwechselstörungen, ­Schwangerschaft und Psyche
© Georg Thieme Verlag KG Stuttgart · New York

Kognitive und affektive Störungen bei Autoimmunthyreoiditis

Cognitive and Affective Disorders in Autoimmune Thyroiditis
K. Müssig
1   Klinik für Endokrinologie und Diabetologie, Universitätsklinikum Düsseldorf
2   Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität Düsseldorf
,
T. Leyhe
3   Universitäre Psychiatrische Kliniken Basel, Universitätsklinikum Basel
› Author Affiliations
Further Information

Publication History

Publication Date:
09 January 2014 (online)

Zusammenfassung

Die Autoimmunthyreoiditis (AIT) ist eine chronische, lymphozytäre Entzündung der Schilddrüse. In Gebieten mit ausreichender Iodversorgung stellt die AIT die häufigste Ursache für eine Hypothyreose dar und wird dann auch als Hashimoto-Thyreoiditis (HT) bezeichnet. Es ist schon lange bekannt, dass Schilddrüsenfunktionsstörungen mit neuropsychiatrischen Auffälligkeiten einhergehen. Erst in den letzten Jahren verdichten sich aber die Hinweise darauf, dass eine AIT auch im euthyreoten Zustand mit kognitiven und affektiven Störungen vergesellschaftet sein kann. Die Hashimoto-Enzephalopathie ist ein seltenes neuropsychiatrisches Krankheitsbild, das durch hohe Schilddrüsenautoantikörper und das gute Ansprechen auf eine Glukokortikoidtherapie gekennzeichnet ist. Aber auch euthyreote HT-Patienten ohne eine Enzephalopathie weisen kognitive Defizite, eine größere psychosoziale Belastung sowie ein erhöhtes Risiko für affektive Störungen auf. Bildgebende Studien weisen auf eine veränderte Perfusion mit Betonung des Frontalhirns sowie auf strukturelle Veränderungen im linken Gyrus frontalis inferior als mögliche Ursachen hin. Die Rolle der Schilddrüsenantikörper in der Pathogenese dieser Veränderungen ist bislang noch nicht geklärt, möglicherweise handelt es sich nur um einen Marker für eine Autoimmunerkrankung des zentralen Nervensystems.

Abstract

Autoimmune thyroiditis (AIT) is a chronic lymphocytic inflammation of the thyroid gland. In areas with sufficient iodine intake, AIT is the most common cause of hypothyroidism and is then termed as Hashimoto’s thyroiditis (HT). It is well known that thyroid function disorders are associated with neuro-psychiatric alterations. However, only in the recent years, hints are growing that AIT is associated with cognitive and affective imbalances also in the euthyroid state. Hashimoto’s encephalopathy is a rare neuropsychiatric entity characterized by high anti-thyroid autoantibodies and a good response to glucocorticoids. However, also euthyroid HT patients without encephalopathy show cognitive deficits, a high psycho-social burden, as well as an increased risk for affective disorders. Imaging studies point to an altered perfusion, in particular, in the frontal lobe and structural changes in the left inferior gyrus frontalis as potential causes. The role of the anti-thyroid antibodies is currently unclear. Maybe they represent a marker of an autoimmune disorder affecting the central nervous system.

 
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