Quality of Life and Mood Disorders in Patients with Hashimoto Thyroiditis

Aim: It is well known that hypothyroidism is associated with poorer quality of life. Still, there are more studies nowadays that also report low health-related quality of life (HRQol), more depression, and anxiety in euthyroid Hashimoto thyroiditis (HT). We hypothesized that autoimmunity itself is associated with low HRQoL and a high prevalence of mood disorders in euthyroid HT. Patients and methods: We examined 130 euthyroid patients with HT (90% females) and 111 matched euthyroid, healthy controls. The groups were subdivided per age: 20-49 yrs. and 50 years. We conducted a cross-sectional analysis. We took blood samples for thyroid hormone levels and thyroid autoantibodies. We examined HRQoL via the health questionnaire (SF-36) short-form version 1 and the presence and degree of mood disorders with the Hospital anxiety and depression scale (HADS) questionnaire. Significant associations between variables were examined with ANOVA analysis and partial correlations. Results: Patients were significantly more depressed than control subjects (p 0.001), and have had more anxiousness, but only in the younger group (p 0.05). Quality of life was significantly better in the older control group comparing to patients with Hashimoto (p 0.01). The overall SF-36 score was in a significant negative correlation with antibodies (TPOAb, TgAb). Depression was positively associated with TSH and TPOAb levels. Conclusion:  Our study indicated that euthyroid patients with HT had worse HRQoL and showed more symptoms of anxiety and depression. We also have found that levels of thyroid antibodies were crucial in terms of neuropsychological wellbeing. More studies with longitudinal observations could explain a possible causal relationship.</p

Intracerebral hemorrhage as a first sign of pheochromocytoma: case report and review of the literature

Pheochromocytomas and sympathetic paragangliomas are rare catecholamine-secreting tumours that represent very rare causes of intracerebral haemorrhage in the young, with only a few cases reported. A 32-year-old man presented to our emergency department because of sudden onset of severe headache. He had a six-month history of paroxysmal headache, palpitations, and sweating. During examination he became somnolent and developed left-sided hemiplegia. A computed tomographic (CT) scan of the brain showed a right temporoparietal haematoma. He was admitted to the Clinic for Neurosurgery and the haematoma was evacuated. The patient was comatose, on assisted respiration, with frequent hypertensive crises. An examination for possible secondary causes of hypertension was undertaken. Plasma metanephrine value was elevated (414 pg/mL, reference values &lt; 90 pg/mL). Abdominal CT scans revealed a large mass (6 cm) in the right adrenal gland. After adequate control of the hypertension was achieved with nonselective alpha- and beta-adrenergic blockers the tumour was excised. The histopathologic findings confirmed the diagnosis of pheochromocytoma. The genetic analysis demonstrated a duplication in exon 1 of the VHL gene. We reported a rare, potentially fatal complication of pheochromocytoma — an intracerebral haemorrhage. This case and review of similar rare cases in the literature illustrate the importance of early recognition of the characteristic symptoms of catecholamine excess in young patients with hypertension