Acute psychosis unveiling diagnosis of hypothyroidism: A case report. (October 2022)

• Record Type: Journal Article
• Authors: Bhattarai, Himal Bikram; Kunwar, Gehendra Jung; Rijal, Ashes; Shah, Sangam; Uprety, Manish; Subedi, Ayusha; Singh, Prabesh Bikram; Khanal, Santosh; Shah, Bidhan Bikram; Rupakheti, Ashim
• Is Part Of: Annals of medicine and surgery. Volume 82(2022)
• Publication Date: 2022-10
• Subjects: Psychosis -- Hypothyroidism -- Diagnosis; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2022.104565
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: Hypothyroidism is a common condition in the general population that presents a wide array of medical, neurological and psychiatric symptoms. However, hypothyroidism rarely leads to acute psychosis, termed myxedema psychosis (MP) and is often missed by many physicians. Case presentation: Here we report a case of a 36-years-old female who presented with a one-week history of abnormal behavior, delusions and hallucinations. Investigations revealed a high thyroid-stimulating-hormone (TSH)of 78.60 mlU/mL and low free thyroxine (FT4) of 0.64 pmol/L. Diagnosed with hypothyroidism, she was treated with oral thyroid hormone replacement (l -thyroxine 75 μg/day) with antipsychotics and her symptoms settled within days. She was discharged off antipsychotics and advised to adhere to thyroxine replacement and to follow up for Thyroid function test (TFT). Discussion: Myxedema psychosis is an uncommon manifestation of the common endocrine disease hypothyroidism. The atypical nature of presentations occasionally complicates diagnostics. When approaching a 'first-episode psychosis, ' it is essential to perform a complete organic screen consistently. Conclusion: Acute myxedema madness should be considered in the differential diagnosis of acute psychosis in patients with hypothyroidism. Highlights: Hypothyroidism rarely leads to acute psychosis, termed myxedema psychosis. Acute myxedema madness should be considered in the differential diagnosis of acute psychosis in patients with hypothyroidism. When approaching a 'first-episode psychosis, ' it is essential to perform a complete organic screen consistently.