Acute psychosis unveiling diagnosis of hypothyroidism: A case report

• Published in: Annals of medicine and surgery (2012) 2022, Vol.82, p.104565-104565
• Main 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
• Format: Report
• Language: English
• ISSN: 2049-0801; 2049-0801
• DOI: 10.1016/j.amsu.2022.104565

IntroductionHypothyroidism 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 presentationHere 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). DiscussionMyxedema 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. ConclusionAcute myxedema madness should be considered in the differential diagnosis of acute psychosis in patients with hypothyroidism.