Antithyroid antibody-linked symptoms in borderline personality disorder


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.

This is a preview of subscription content, access via your institution.


  1. 1.

    Nemeroff, C. B., Simon, J. S., Haggerty, J. J. Jr., and Evans, D. L. (1985). Am. J. Psychiatry 142, 840–843.

    PubMed  CAS  Google Scholar 

  2. 2.

    Joffe, R. T. (1987). Acta Psychiatr. Scand. 76, 598–599.

    PubMed  CAS  Google 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.

    PubMed  Article  Google Scholar 

  4. 4.

    Haggerty, J. J. Jr., Silva, S. G., Marquardt, M., et al. (1997). Depression Anxiety 5, 91–96.

    Article  Google Scholar 

  5. 5.

    Harris, B. (1999). Thyroid 7, 699–703.

    Article  Google Scholar 

  6. 6.

    Kupka, R. W., Nolen, W. A., Post, R. M., et al. (2002). Biol. Psychiatry 51(4), 305–311.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Hollowell, J. G., Staehling, N. W., Flanders, W. D., et al. (2002). J. Clin. Endocrinol. Metab. 87, 489–499.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Bokhari, R., Bhatara, V. S., Bandettini, F., and McMillan, J. M. (1998). Psychoneuroendocrinology 23, 643–650.

    PubMed  Article  CAS  Google 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.

    PubMed  CAS  Google 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.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Loosen, P. T. and Prange, A. J. Jr. (1982). Am. J. Psychiatry 139, 405–416.

    PubMed  CAS  Google 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.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Shaw, P. J., Walls, T. J., Newman, P. K., Cleland, P. G., and Cartlidge, N. E. (1991). Neurology 41, 228–233.

    PubMed  CAS  Google Scholar 

  17. 17.

    Vasconcellos, E., Pina-Garza, J. E., Fakhoury, T., and Fenichel, G. M. (1999). Pediatr. Neurol. 20, 394–398.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Marcenaro, M., Prete, C., Badini, A., Sulli, A., Magi, E., and Cutolo, M. (1999). Ann. NY Acad. Sci. 876, 419–425.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Hayman, B. and Bansal, A. (2002). BMJ 325, 1213.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Roy-Byrne, P. P., Joffe, R. T., Uhde, T. W., and Post, R. M. (1984). Arch. Gen. Psychiatry 41, 1150–1153.

    PubMed  CAS  Google Scholar 

  21. 21.

    Nishino, M., Yabe, S., Murakami, M., Kanda, T., and Kobayashi, I. (2001). Endocr. J. 48, 185–191.

    PubMed  CAS  Google Scholar 

  22. 22.

    Gold, P. W., Licinio, J., Wong, M. L., and Chrousos, G. P. (1995). Ann. NY Acad. Sci. 771, 716–729.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Geracioti, T. D. Jr., Loosen, P. T., and Orth, D. N. (1997). Biol. Psychiatry 42, 165–174.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Dr. Thomas D. Geracioti Jr..

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Geracioti, T.D., Kling, M.A., Post, R.M. et al. Antithyroid antibody-linked symptoms in borderline personality disorder. Endocr 21, 153–158 (2003).

Download citation

Key Words

  • Borderline personality disorder
  • carbamazepine
  • antithyroid antibodies
  • cortisol
  • Hashimoto thyroiditis