Acute psychosis caused by hypothyroidism following radioactive iodine treatment of Graves’ disease

Hyams, Catherine; Joshi, Pavan; Foster, Paul M.D.; Katz, J. I.

doi:10.1177/2042533313476858

Cited by 10 publications

(15 citation statements)

References 8 publications

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“…A Medline search from 1949 to the present using the terms ‘hypothyroidism’, ‘radioactive iodine’, ‘myxoedema madness’ and ‘acute psychosis’ found only one case report suggesting a relationship between acute hypothyroidism following radioactive iodine ablation in a patient with Graves' disease and psychosis (6). This case was very similar to ours.…”

Section: Discussionsupporting

confidence: 81%

Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

Larouche

Snell

Morris

2015

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryMyxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months after treatment with radioactive iodine ablation for Graves' disease. Her psychiatric symptoms abated with levothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism from bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be a complication of acute hypothyroidism following radioactive iodine ablation of Graves' disease and that primary hyperaldosteronism may be associated with autoimmune hyperthyroidism.Learning points Psychosis (myxoedema madness) can present as a neuropsychiatric manifestation of acute hypothyroidism following radioactive iodine ablation of Graves' disease.Primary hyperaldosteronism may be caused by idiopathic bilateral adrenal hyperplasia even in the presence of an adrenal adenoma seen on imaging.Adrenal vein sampling is a useful tool for differentiating between a unilateral aldosterone-producing adenoma, which is managed surgically, and an idiopathic bilateral adrenal hyperplasia, which is managed medically.The management of autoimmune hyperthyroidism, iatrogenic hypothyroidism and primary hyperaldosteronism from bilateral idiopathic adrenal hyperplasia in patients planning pregnancy includes delaying pregnancy 6 months following radioactive iodine treatment and until patient is euthyroid for 3 months, using amiloride as opposed to spironolactone, controlling blood pressure with agents safe in pregnancy such as nifedipine and avoiding β blockers.Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist; any underlying mechanism associating the two is still unclear.

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Section: Discussionsupporting

confidence: 81%

Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

Larouche

Snell

Morris

2015

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…One should also consider a possibility of the role of thyroid autoimmunity in pathogenesis of polyneuropathy and low probability of direct toxic effect of radioactive iodine. After the application of therapeutical radioactive iodine doses, the controls for thyroid hormone levels are far more frequently required than recommended in clinical practice (2), (24), and the doctors must be aware of the risk of unrecognized dysfunction of thyroid gland and consequential brutal metabolic collapse (25) (26).…”

Section: Resultsmentioning

confidence: 99%

“…Ostavljena je mogu nost i za ulogu tireoidne autoimunosti u patogenezi polineuropatije i malo verovatnog direktnog toksi nog dejstva radioaktivnog joda. Nakon primene terapijske doze radioaktivnog joda potrebne su daleko eš e kontrole tireoidnih hormona nego što se preporu uju u klini koj praksi (2) (24), a lekari moraju biti svesni rizika koje neprepoznati nagli prestanak funkcije štitne žlezde i posledi ni brutalni metaboli ki sunovrat nose (25) (26). Kombinovana T4/T3 terapija je kod naše pacijentkinje imala povoljne efekte na simptome hipotireoze vezane za centralni nervni sistem, dovela je do zna ajnog smanjenja serumske koncentracije ukupnog i LDL holesterola i do normalizacije odnosa serumskih koncentracija FT3 i FT4, makar u prvim asovima nakon primene leka.…”

Section: Zaklju Akunclassified

The acute myxedema after hyperthyroidism treated by radioactive iodine and its sequelae

Ivkovic¹

2013

Med gl Ins stit Zlatibor

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Sažetak:Prikazujemo slu aj pacijentkinje kod koje je, nakon terapije Graves-ove hipertireoze radioaktivnim jodom, nastala teška, klini ki manifestna hipotireoza u okviru koje je došlo do razvoja pretežno senzitivne neuropatije dominantno aksonalnog tipa. Pored simptoma i neuro zioloških znakova polineuropatije, kod pacijentkinje su se tokom 2 godine naizgled adekvatne monoterapije hipotireoze levotiroksinom održavali hipotireoidni simptomi od strane CNS-a, povišene serumske koncentracije ukupnog i LDL holesterola i klini ki znakovi pove anog perifernog vaskularnog otpora. Održavao se ne ziološki odnos serumskih koncentracija FT3 i FT4, uz serumske koncentracije TSH i FT4 koje su ukazivale na smanjenu osetljivost tireoidno-hipo zne negativne povratne sprege. Nakon zapo injanja kombinovane LT4/LT3 supstitucione terapije veoma brzo je došlo do nestanka hipotireoidnih simptoma vezanih za CNS, zna ajnog smanjenja serumskih koncentracija ukupnog i LDL holesterola, normalizacije FT3/FT4 odnosa makar u prvim asovima nakon uzimanja leka, nestanka klini kih znakova pove anog perifernog vaskularnog otpora. Stepen polineuropatskih tegoba se smanjio do nivoa kad ne ometa spavanje. Vreme i kontrolna ENG e pokazati kakvi e biti de nitivni efekti kombinovane T4/T3 terapije na ošte enja perifernih nerava. Tokom prvih 6 meseci nisu zabeleženi neželjeni efekti kombinovane T4/T3 terapije.Klju ne re i: radioaktivni jod, hipertireoza, polineuropatija, hipotireoza, T4/T3 terapija * Staša Ivkovi , Klinika za ORL i MFH Klini kog centra Srbije.

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“…In 1949, Asher reported 14 cases of psychosis with hypothyroidism, 9 of which recovered with thyroid hormone treatment alone [2]. Numerous cases have since linked psychosis to hypothyroidism [2,[6][7][8][9][10][11][12].The majority of these cases were managed with a combination of antipsychotic medication and thyroid replacement, however in some cases maintenance therapy included thyroid replacement alone. There was no correlation between the degree of hypothyroidism and the severity of psychiatric symptoms [2].…”

Section: Discussionmentioning

confidence: 99%

Severe Hypothyroidism Presenting with Acute Mania and Psychosis: A Case Report and Literature Review

Zorkin¹,

Golts²,

Fernandes³

2017

Bipolar Disord

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Introduction: In patients presenting with acute mania and psychosis, it is important to rule out organic causes of their symptoms. Patients with severe hypothyroidism may present with psychosis and less commonly with symptoms of mania. We report a case of a 40 year old male presenting with acute mania and psychosis, in the context of severe hypothyroidism. Case presentation: A 40 year old Caucasian male presented to the emergency department with acute onset mania, and delusions of grandeur. One week prior to presentation, he demonstrated bizarre behavior and hyperactivity. On the day of admission, he sustained a self-inflicted burn on his left arm and left leg causing partial thickness burns. Blood work demonstrated elevated creatine kinase and creatinine, as well as profoundly high TSH (>100 uIU/L) and low thyroid hormones (T4=2 pmol/L, T3 1.9=pmol/L). He was medically diagnosed with rhabdomyolysis with acute kidney injury and severe hypothyroidism. He was started on antipsychotic medication (loxapine), a mood stabilizer (divalproex sodium) and levothyroxine. His psychosis and mania resolved after 2 weeks in hospital and TSH trended down (84.10 mIU/L) and free T4 (9 pmol/L) and free T3 (3.8 pmol) trended upwards. Conclusion: In patients presenting with severe hypothyroidism and acute mania with psychosis, treatment should include thyroid hormone replacement in addition to psychotropic medications.

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Acute psychosis caused by hypothyroidism following radioactive iodine treatment of Graves’ disease

Cited by 10 publications

References 8 publications

Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

The acute myxedema after hyperthyroidism treated by radioactive iodine and its sequelae

Severe Hypothyroidism Presenting with Acute Mania and Psychosis: A Case Report and Literature Review

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