Images In...

Stabbing? Cause

John Matthew O’Callaghan¹, Jessica Bewick², Alistair Paice², Philip Ng²

¹ George Eliot Hospital, General Surgery, College Street, Nuneaton, CV10 1DJ, UK
² University Hospital Lewisham, General Surgery, Lewisham High Street, London, SE13 6LH, UK

Correspondence to:
John Matthew O’Callaghan, ocallaghan.john{at}gmail.com

A 57-year-old woman presented to the Casualty department with seven self-inflicted superficial stab wounds to the neck and one to the abdominal wall: a deliberate suicide attempt following 2 years of depression. All wounds were sutured in Casualty, where a thin, transverse scar was noted above the suprasternal notch (fig 1). This scar had been present for 20 years following the removal of a thyroid tumour, yet the patient was not taking thyroid replacement therapy. On reflection, the patient had the classical signs and symptoms of hypothyroidism: dry skin and hair, a "peaches and cream" complexion, slow voice, weight gain, constipation and fatigue. Thyroid function tests showed thyroid-stimulating hormone (TSH) of 14 µU/litre, free T4<5.2 pmol/litre. The patient was given levothyroxine, which resulted in a change of mood and increased activity within 48 h. On later careful history taking, the patient explained she had resigned from her high-flying career due to ill health, feeling unable to cope with the pace of the job.

View this figure (95K): in this window | in a new window | PowerPoint for Teaching   Figure 1 Closer inspection of the neck revealed a thyroidectomy scar amongst the stab wounds.

 

A large number of medical conditions are significantly more common amongst patients with recurrent depression.¹ However, when corrected for body mass index (BMI), gender and age, depression remains a predictive factor for six disorders: thyroid disease, gastric ulcer, rhinitis, osteoarthritis, hypertension and asthma.¹ Thyroid disorders in particular are more than twice as common.¹ Patients discharged with a diagnosis of hypothyroidism have a greater risk of subsequent admission with depression or bipolar disorder.² This case highlights the importance of investigating medical causes for depression in cases of attempted suicide.

Competing interests: None.

Patient consent: Patient/guardian consent was obtained for publication.

1. Farmer, J, et al. Medical disorders in people with recurrent depression. Br J Psych 2008; 192: 351–5.[Abstract/Free Full Text]
2. Thomsen, HF, et al. Increased risk of developing affective disorder in patients with hypothyroidism: a register based study. Thyroid 2005; 15: 700–7.[CrossRef][Medline]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?