晚發性躁症與亞臨床型甲狀腺機能亢進：個例報告

Late-onset Mania and Subclinical Hyperthyroidism: A Case Report

黃斯聖(Si-Sheng Huang)；王介暉(Chieh-Hui Wang)；邱南英(Nan-Ying Chiu)

次發性 ； 雙相情感疾病 ； 甲狀腺機能亢進 ； secondary ； bipolar disorder ； hyperthyroidism

The Changhua Journal of Medicine

9卷s期（2004 / 12 / 01）

272 - 276

繁體中文

背景及目的：次發性的雙相情感疾病其器質性之因素有毒素、代謝異常、感染、頭部外傷、腦血管中風和老化。本文所要介紹的是一個晚發性躁症與亞臨床型甲狀腺機能亢進(subclinical hyperthyroidism)的病例，並且對相關的文獻做整理回顧，試著去探討亞臨床型甲狀腺機能亢進的病因、臨床表徵、及與精神疾病和症狀的相關性。 病例報告：患者為五十六歲已婚男性，在五十二歲時第一次發作精神症狀，至今已發作四次，此次入院後發現患者的血清TSH值小於0.004μU/mL，T4值為11.0μg/dL，診斷為亞臨床型甲狀腺機能亢進，此發現被懷疑與病人躁症發作有關。 結論：亞臨床型甲狀腺機能亢進其精神症狀的臨床表現沒有特異性，以病患的臨床症狀來診斷其所導致之情感性疾患有其困難性。但是臨床醫師在情感性疾患病人住院以後，應該常規檢測甲狀腺功能，以提供治療的參考。次發於甲狀腺機能亢進的躁症發作，其臨床症狀及病程，仍需要更多臨床經驗及進一步研究。

Background and purpose: Causes of secondary bipolar disorder include toxins, metabolic disorders, infections, head trauma, stroke and aging. We present a case of late-onset mania associated with subclinical hyperthyroidism. The related literature is reviewed and the etiologies, clinical manifestations, and psychiatric aspects of subclinical hyperthyroidism discussed. Case report: The patient is a 56 year old male. Psychiatric symptoms were first noted at age 52. with at least four manic episodes since. Low serum TSH (＜0.004 μU/mL) and borderline serum total T4 (11.0 μg/dL) were found during hospitalization. A manic episode associated with subclinical hyperthyroidism is highly suspected. Conclusion: The psychiatric manifestations of subclinical hyperthyroidism are nonspecific. It is difficult to diagnose the disease by symptoms and signs. When a patient is admitted to a psychiatric ward due to mood disorder, thyroid function should be evaluated routinely. The clinical manifestations and course of mania secondary to hyperthyroidism may be clarified by greater clinical experience.