, Volume 21, Issue 2, pp 153–158 | Cite as

Antithyroid antibody-linked symptoms in borderline personality disorder

  • Thomas D. GeraciotiJr.
  • Mitchel A. Kling
  • Robert M. Post
  • Philip W. Gold


Circulating thyroid autoantibodies are more prevalent in patients with mood disorders than in the general population, but longitudinal clinical data that establish a relationship between thyroid antibody status and the course of any psychiatric syndrome have been lacking. In addition, scant attention has been paid to thyroid hormones and autoimmunity in borderline personality disorder (BPD). We report a case of a patient with classic BPD whose fluctuating mood and, especially, psychotic symptoms—rated using a double-blind method—were directly linked to antithyroglobulin antibody titers serially determined over an inpatient period of 275 d. Significantly lower psychosis and depression ratings were seen during a 4-wk period of relatively low antithyroid antibody titers, during blinded treatment with carbamazepine, than were observed during two high autoantibody epochs. The significant positive correlations between nurse- and patient-rated depression and thyroid autoantibodies over the entire period of inpatient study were similar to those also observed between urinary free cortisol levels and depression; the positive correlation between antithyroglubulin antibody titers and psychotic symptoms was stronger (r=+0.544; p<0.002). Although this patient had biochemical indices of primary hypothyroidism, she showed only marginal improvement to triiodothyronine (T3) and no apparent clinical response to sustained levorotatory thyroxine (T4) administration; neither were antithyroid antibody titers significantly associated with changes in T3, free T4, or thyroid-stimulating hormone concentrations. She clinically deteriorated during a 50-d fluoxetine trial. The present data demonstrate a clinically significant, longitudinal correlation between fluctuating antithyroid antibody titers and symptoms of borderline psychopathology in our patient. It will be of interest to determine the prevalence, pathophysiologic mechanisms, and treatment implications of this putative autoimmune-BPD link.

Key Words

Borderline personality disorder carbamazepine antithyroid antibodies cortisol Hashimoto thyroiditis 


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  1. 1.
    Nemeroff, C. B., Simon, J. S., Haggerty, J. J. Jr., and Evans, D. L. (1985). Am. J. Psychiatry 142, 840–843.PubMedGoogle Scholar
  2. 2.
    Joffe, R. T. (1987). Acta Psychiatr. Scand. 76, 598–599.PubMedGoogle Scholar
  3. 3.
    Haggerty, J. J., Evans, D. L., Golden, R. N., Pedersen, C., Simon, J., and Nemeroff, C. (1990). Biol. Psychiatry 27, 51–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Haggerty, J. J. Jr., Silva, S. G., Marquardt, M., et al. (1997). Depression Anxiety 5, 91–96.CrossRefGoogle Scholar
  5. 5.
    Harris, B. (1999). Thyroid 7, 699–703.CrossRefGoogle Scholar
  6. 6.
    Kupka, R. W., Nolen, W. A., Post, R. M., et al. (2002). Biol. Psychiatry 51(4), 305–311.PubMedCrossRefGoogle Scholar
  7. 7.
    Hollowell, J. G., Staehling, N. W., Flanders, W. D., et al. (2002). J. Clin. Endocrinol. Metab. 87, 489–499.PubMedCrossRefGoogle Scholar
  8. 8.
    Bokhari, R., Bhatara, V. S., Bandettini, F., and McMillan, J. M. (1998). Psychoneuroendocrinology 23, 643–650.PubMedCrossRefGoogle Scholar
  9. 9.
    Schmidt, P. J., Rosenfeld, D., Muller, K. L., Grover, G. N., and Rubinow, D. R. (1990). J. Clin. Psychiatry 51, 434–436.PubMedGoogle Scholar
  10. 10.
    American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, 4th ed. American Psychiatric Association, Washington, DC.Google Scholar
  11. 11.
    Garbutt, J. C., Loosen, P. T., Tipermas, A., and Prange, A. J. Jr. (1983). Psychiatry Res. 9, 107–113.PubMedCrossRefGoogle Scholar
  12. 12.
    Loosen, P. T. and Prange, A. J. Jr. (1982). Am. J. Psychiatry 139, 405–416.PubMedGoogle Scholar
  13. 13.
    Bunney, W. E. Jr. and Hamburg, D. A. (1963). Arch. Gen. Psychiatry 17, 280–294.Google Scholar
  14. 14.
    Weetman, A. P. (2000). In: The thyroid: a fundamental and clinical text. Braverman, L. E. and Utiger, R. D. (eds.). Lippincott: Philadelphia.Google Scholar
  15. 15.
    Brain, L., Jellinek, E. H., and Ball, K. (1966). Lancet 2, 512–514.PubMedCrossRefGoogle Scholar
  16. 16.
    Shaw, P. J., Walls, T. J., Newman, P. K., Cleland, P. G., and Cartlidge, N. E. (1991). Neurology 41, 228–233.PubMedGoogle Scholar
  17. 17.
    Vasconcellos, E., Pina-Garza, J. E., Fakhoury, T., and Fenichel, G. M. (1999). Pediatr. Neurol. 20, 394–398.PubMedCrossRefGoogle Scholar
  18. 18.
    Marcenaro, M., Prete, C., Badini, A., Sulli, A., Magi, E., and Cutolo, M. (1999). Ann. NY Acad. Sci. 876, 419–425.PubMedCrossRefGoogle Scholar
  19. 19.
    Hayman, B. and Bansal, A. (2002). BMJ 325, 1213.PubMedCrossRefGoogle Scholar
  20. 20.
    Roy-Byrne, P. P., Joffe, R. T., Uhde, T. W., and Post, R. M. (1984). Arch. Gen. Psychiatry 41, 1150–1153.PubMedGoogle Scholar
  21. 21.
    Nishino, M., Yabe, S., Murakami, M., Kanda, T., and Kobayashi, I. (2001). Endocr. J. 48, 185–191.PubMedGoogle Scholar
  22. 22.
    Gold, P. W., Licinio, J., Wong, M. L., and Chrousos, G. P. (1995). Ann. NY Acad. Sci. 771, 716–729.PubMedCrossRefGoogle Scholar
  23. 23.
    Geracioti, T. D. Jr., Loosen, P. T., and Orth, D. N. (1997). Biol. Psychiatry 42, 165–174.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc 2003

Authors and Affiliations

  • Thomas D. GeraciotiJr.
    • 1
    • 3
  • Mitchel A. Kling
    • 1
  • Robert M. Post
    • 2
  • Philip W. Gold
    • 1
  1. 1.Clinical NeuroendocrinologyNational Institute of Mental HealthBethesda
  2. 2.Biological Psychiatry BranchesNational Institute of Mental HealthBethesda
  3. 3.The University of Cincinnati and Veterans Affairs Medical CentersCincinnati

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