Intrathecal Thyroid Autoantibody Synthesis in a Subgroup of Patients With Schizophreniform Syndromes
Abstract
How to Deal With Increased Antithyroid Autoantibodies in Schizophreniform Disorders
Rationale of Our Study
Methods
Study Sample
Schizophreniform Patient Cohort (N=100) | Number of Patients |
---|---|
Schizophrenia | 56 |
Schizoaffective disorder | 29 |
Acute polymorphic psychotic disorder | 14 |
Substance-induced psychosis | 1 |
Diagnostic Measurements | Number of Samples |
Antithyroid peroxidase and anti-thyroglobulin antibodies | 100a |
CSF basis diagnostics (white blood cell count, protein concentration, albumin quotient, and intrathecal immunoglobulin synthesis) | 100 |
Electroencephalography data sets | 100 |
Magnetic resonance imaging data sets | 93 |
ELISA
Specific Antibody Index
Data Handling and Statistical Analysis
Results
Demographic Data
Thyroid Hormones and Antithyroid Antibody Findings
Hormones and Autoantibodies | Mean±SD (N=100) | Number of Alterations | Frequency of Alterations | Reference Values |
---|---|---|---|---|
Thyroid-stimulating hormone | 2.39±2.24 | ↔: 88 | 12% | 0.27–4.20 µU/ml |
↑: 9 | ||||
↓: 3 | ||||
Triiodothyronine | 4.73±0.90 | ↔: 92 | 8% | 3.4–6.8 pmol/l |
↑: 2 | ||||
↓: 6 | ||||
Thyroxine | 16.60±3.23 | ↔: 94 | 6% | 10.6–22.7 pmol/l |
↑: 4 | ||||
↓: 2 | ||||
Antithyroid peroxidase antibodies in serum | 50.15±104.96 | ↔: 82 | 18% | <50 IU/ml |
↑: 18 | ||||
Antithyroglobulin antibodies in serum | 14.87±23.79 | ↔: 98 | 2% | <100 IU/ml |
↑: 2 |
Antibody Type | Serum Autoantibodies (N=100) | Specific Antibody Index | Frequency of Increased Specific Antibody Indices |
---|---|---|---|
Antithyroid peroxidase antibodies | ↑: 18 | ↑: 12 | In the entire cohort: 12% |
↔: 82 | ↔: 88b | In seropositive patients: 66.7% | |
Antithyroglobulin antibodies | ↑: 2 | ↑: 1 | In the entire cohort: 1% |
↔: 98 | ↔: 99b | In seropositive patients: 50% |
Item | Age (Years), Gender, Syndrome | Serum Anti-TPO | AI Anti-TPO | Serum Anti-TG | AI Anti-TG | Thyroid Status | CSF | cMRI | EEG | Overall Alterations |
---|---|---|---|---|---|---|---|---|---|---|
1 | 19 years, female, schizoaffective disorder | 213.24 (↑) | 2.11 (↑) | ↔ | ↔ | TSH: ↔ | Normal | Asymmetry of ventricles; one isolated WM lesion | Interm. gen. slow activity | AI TPO ↑ |
T3: ↔ | cMRI | |||||||||
T4: ↔ | EEG | |||||||||
2 | 25 years; female, paranoid-hallucinatory schizophrenia | 66.60 (↑) | 4.39 (↑) | ↔ | ↔ | TSH: ↔ | Normal | Enlarged Virchow-Robin's space | Normal | AI TPO ↑ |
T3: ↔ | cMRI | |||||||||
T4: ↔ | ||||||||||
3 | 37 years; female, paranoid-hallucinatory schizophrenia | 216.87 (↑) | 6.17 (↑) | 126.23 (↑) | ↔ | TSH: ↔ | Slight BBB-dysfunction (protein concentration: 532 mg/L; albumin quotient: 6.6b) | Asymmetry of ventricles with enlarged right lateral ventricle | Interm. bitemporal theta/delta slowing | AI TPO ↑ |
T3: ↔ | CSF | |||||||||
T4: ↔ | cMRI | |||||||||
EEG | ||||||||||
4 | 49 years, female, acute polymorph psychotic disorder with schizophreniform symptoms | 153.29 (↑) | 1.84 (↑) | ↔ | ↔ | TSH: 0,03 (↓) | Normal | Isolated unspecific white matter lesions | Normal | AI TPO ↑ |
T3: ↔ | TH | |||||||||
T4: ↔ | cMRI | |||||||||
5 | 31 years, female, paranoid-hallucinatory schizophrenia | 62.96 (↑) | 5.17 (↑) | ↔ | ↔ | TSH: ↔ | Normal | Isolated unspecific frontal white matter lesions; asymmetry of ventricles with enlarged left lateral ventricle | Normal | AI TPO ↑ |
T3: ↔ | cMRI | |||||||||
T4: ↔ | ||||||||||
6 | 25 years, male, schizoaffective disorder | 88.25 (↑) | 2.32 (↑) | ↔ | ↔ | TSH: ↔ | Normal | Normal | Interm. frontal slowing | AI TPO ↑ |
T3: ↔ | EEG | |||||||||
T4: ↔ | ||||||||||
7 | 30 years, female, schizoaffective disorder | 697.28 (↑) | 8.16 (↑) | ↔ | ↔ | TSH: ↔ | Normal | Posttraumatic changes with a right frontal contusion lesion: right side accentuated gliosis of WM | Normal | AI TPO ↑ |
T3: ↔ | cMRI | |||||||||
T4: ↔ | ||||||||||
8 | 24 years, male, paranoid-hallucinatory schizophrenia | 183.83 (↑) | 2.38 (↑) | ↔ | ↔ | TSH: ↔ | Distinct BBB-dysfunction (protein concentration: 1510 mg/L; albumin quotient: 20.8) | Normal | Interm. general. theta/delta slowing; rare epileptic activity | AI TPO ↑ |
T3: ↔ | CSF | |||||||||
T4: ↔ | EEG | |||||||||
9 | 49 years, female, schizoaffective disorder | 54.24 (↑) | 3.76 (↑) | ↔ | ↔ | TSH: 0.25 (↓) | One isolated band in CSF and serum | Isolated unspecific white matter lesions | Intermitt. general. theta slowing | AI TPO ↑ |
T3: ↔ | TH | |||||||||
T4: 23.40 (↑) | CSF | |||||||||
cMRI | ||||||||||
EEG | ||||||||||
10 | 52 years, female, schizoaffective disorder | 319.53 (↑) | 7.65 (↑) | ↔ | ↔ | TSH: 6.83 (↑) | Identical oligoclonal bands in CSF and serum | Normal | Normal | AI TPO ↑ |
T3: ↔ | TH | |||||||||
T4: ↔ | CSF | |||||||||
11 | 21 years, female, paranoid-hallucinatory schizophrenia | 166.91 (↑) | 1.54 (↑) | ↔ | ↔ | TSH: ↔ | Normal | Slightly enlarged perivascular spaces in the basal ganglia on both sides | Normal | AI TPO ↑ |
T3: ↔ | cMRI | |||||||||
T4: ↔ | ||||||||||
12 | 21 years, female, paranoid-hallucinatory schizophrenia | 96.02 (↑) | 1.67 (↑) | ↔ | ↔ | TSH: ↔ | Normal | Normal | Normal | AI TPO ↑ |
T3: ↔ | ||||||||||
T4: ↔ | ||||||||||
13 | 61 years, female, schizoaffective disorder | ↔ | ↔ | 112.67 (↑) | 1.84 (↑) | TSH: ↔ | Slight increased protein concentration (556 mg/L) | Unspecific white matter lesions | Normal | AI TG ↑ |
T3: ↔ | cMRI | |||||||||
T4: ↔ | CSF |
Clinical Characteristics of Schizophreniform Patients With Increased AIs
Measurement | Patients With Increased AIs (N=13) | Patients With Normal AIs (N=87) | p | ||||||
---|---|---|---|---|---|---|---|---|---|
Mean±SD | Number of Cases | Frequency of Alterations | Mean±SD | Number of Cases | Frequency of Alterations | Statistics | |||
Serumb | |||||||||
TSH | 2.29±1.90 | ↔: 10 | 23.1% | 2.40±2.29 | ↔: 78 | 10.3% | p=0.865 | ||
↑: 1 | ↑: 8 | ||||||||
↓: 2 | ↓: 1 | ||||||||
(range: 0.03–6.83) | (range: 0.06–19.32) | ||||||||
T3 | 4.66±0.81 | 0% | 4.74±0.92 | ↔: 79 | 9.2% | p=0.784 | |||
↔: 13 | ↑: 2 | ||||||||
↑↓: 0 | ↓: 6 | ||||||||
(range: 3.84–6.52) | (range: 2.43–7.20) | ||||||||
T4 | 17.29±2.67 | 7.7% | 16.50±3.31 | ↔: 82 | 5.7% | p=0.410 | |||
↔: 12 | ↑: 3 | ||||||||
↑: 1 | ↓: 2 | ||||||||
(range: 12.50–23.40) | (range: 9.20–26.30) | ||||||||
CSFb | |||||||||
White blood cell count | 1.46±0.66/µl | 1–4 cells: | 0% | 2.29±6.32/µl | 1–4 cells: | 2.3% | p=0.639 | ||
13 | 84 | ||||||||
≥5 cells: | ≥5 cells: 2 | ||||||||
0 | (range: 1–59 cells/µl) | ||||||||
(range: 1–3 cells/µl) | |||||||||
Protein concentration | 432.62±341.72 mg/l | ↔: 10 | 23.1% | 450.39±303.39 mg/l | ↔: 51 | 41.4% | p=0.847 | ||
↑: 3 (range: 206–1510 mg/l) | ↑: 36 (range: 165–2890 mg/l) | ||||||||
Albumin quotient | 5.58±4.78 | ↔: 11 | 15.4% | 5.80±4.17 | 19.54% | p=0.867 | |||
↑: 2 | ↔: 70 | ||||||||
(range: 2.50–20.8) | ↑: 17 (range: 2.00–38.70) | ||||||||
Immunoglobulin-G-index | 0.48±0.05 mg/l | ↔: 13 | 0% | 0.50±0.08 mg/l | ↔: 85 | 2.3% | p=0.558 | ||
↑: 0 | ↑: 2 | ||||||||
(range: 0.41–0.61 mg/l) | (range: 0.42–0.95 mg/l) | ||||||||
Oligoclonal bands | No: 11 | 15.4% restricted to CSF: 7.7% mirror pattern: 7.7% | No: 80 | 8% restricted to CSF: 2.3% mirror pattern: 5.7% | |||||
Yes: 2 (restricted to CSF: 1; OCBs mirror pattern: 1) | Yes: 7 (restricted to CSF: 2; OCBs mirror pattern: 5) | ||||||||
Number of Cases | Frequency | Number of Cases | Frequency | Statistics | |||||
cMRIc | |||||||||
White matter lesions/cerebral microangiopathy | 5/13 | 38.5% | 19/80 | 23.8% | |||||
Generalized cortical atrophy | 0/13 | 0% | 3/80 | 3.8% | |||||
Localized cortical atrophy | 0/13 | 0% | 1/80 | 1.3% | |||||
Other alterations | 1/13 | 7.7% | 5/80 | 6.3% | |||||
Number of Cases | Frequency | Number of Cases | Frequency | Statistics | |||||
Anatomic variations | 3/13 | 23.1% | 5/80 | 6.3% | |||||
Overall alterations | Yes: 9 | Yes: 33 | p=0.060 | ||||||
No: 4 | No: 47 | ||||||||
EEGc | |||||||||
Continuous generalized slow activity | 0/13 | 0% | 2/87 | 2.3% | |||||
Continuous regional slow activity | 0/13 | 0% | 0/87 | 0% | |||||
Intermittent generalized slow activity | 3/13 | 23.1% | 20/87 | 23.0% | |||||
Intermittent regional slow activity | 1/13 | 7.7% | 3/87 | 3.4% | |||||
Epileptic activity | 1/13 | 7.7% | 1/87 | 1.1% | |||||
Overall alterations | Yes: 5 | Yes: 26 | p=0.533 | ||||||
No: 8 | No: 61 |
Characteristics of Patients With Normal and Increased AIs
Discussion
Our Findings in the Context of Earlier Findings
Pathophysiological Meaning of Increased AIs
The Role of Antithyroid AI Measurement in Diagnostic Procedures
Limitations
Conclusions
References
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Competing Interests
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